Health insurers aim at hospitals

Written By miftah nugraha on Minggu, 10 Maret 2013 | 19.55

STANDARDS in some private hospitals around the nation are so bad that health insurers don't want to cover procedures done in them.

Private Healthcare Australia, representing the nation's health insurers, commissioned a leading academic to assess four years of data on as many as 600 private hospitals and apply gradings from "A-triple-plus" to "C-triple-minus".

Some Tasmanian facilities have been included in the report and 166 of the hospitals are in Victoria.

Insurers want to cut off "C-triple-minus" facilities, where operations are most likely to: INFECT patients with bacteria such as golden staph; LEAVE hospital patients in intensive care; or REQUIRE procedures to be redone.

The insurers want to release the research, arguing the community has a right to know.

However, they have decided to not publish it for fear of being sued by staff at the sub-standard hospitals.

The insurers also believe that if the research made public it would help them to make the case for refusing to pay shoddy facilities, or to pay less.

This, they say, would lead to lower premiums.

An operation that goes bad could end up costing hundreds of thousands of dollars.

"If we don't have to cover that, we don't have to ask as high a premium increase next year," said Dr Michael Armitage, CEO of the body which commissioned the research, Private Healthcare Australia (PHA), the official representative of the nation's health insurers.

Premiums have been rising at twice the rate of inflation for more than a decade.

Australian Medical Association Tasmanian president John Davis said with the report not being released, it was impossible to comment on its contents but said there was no reason for Tasmanians to be concerned.

"There is no reason to believe that private hospitals in Tasmania provide anything other than quality care," Dr Davis said.

"I expect all private hospitals here are accredited by their independent group, the ACHS (Australian Council on Healthcare Standards)."

The rapidly increasing cost of cover prompted News Limited to join forces with consumer network One Big Switch in the Big Health Insurance Switch campaign.

In just two weeks more than 60,000 people have joined the campaign by registering an interest in receiving a no-obligation discount health insurance offer.

Registration is free.

The PHA does not support the campaign.

Rather, Dr Armitage said, the "real gain" was in "fixing rats**t outcomes" that drive up costs.

"There are a whole lot [of hospitals] that are C-triple-minus," Dr Armitage said.

"And we just keep backing up the truck full of gold bars" to pay them.

Private hospitals perform about two-thirds of all elective surgery.

The unpublished hospital research was based on figures from 2004 to 2007 using the 25 million "data points" insurers gather each year.

The work was completed in 2009.

Since then the PHA has been fighting to get the findings into the public domain.

It lobbied politicians from both sides and even sought advice from the Privacy Commissioner.

Dr Armitage said the advice was that the PHA would be sued.

The battle to make the research public has taken the PHA so long that Dr Armitage said that even if it could now be released it would need to be done again to bring it up to date.

He would not release details of the research to News Limited.

Dr Armitage, who was South Australia's health minister until 2002, said private health insurers "are not utilised appropriately in helping the health system get over its problems".

"The real gain for the health system is in fixing rats**t outcomes. But governments of all persuasions won't let us off the leash."

Australian Private Hospitals Association (APHA) CEO Michael Roff said he was not aware of the insurers' research.

"If they have that data they've never shared it with the APHA or with any individual hospitals," Mr Roff said, adding that he was willing to see it.

Mr Roff also said there was "nothing to stop a private health insurer from not entering into a contract with one or more hospitals".

He wasn't aware of that having happened.

A spokesman for federal Health Minister Tanya Plibersek said her office would like to see the research.

Without seeing it, the minister was unable to comment.

Dr Armitage said the Productivity Commission had found private hospitals, on average, offered higher quality treatment than public.

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