Doctors Welcome Clarity On Private Health Reforms
By: Gold Coast Spine
Proposed policy bands of Gold, Silver, Bronze and Basic split cover for spinal conditions between Silver and Gold, which would have forced more people to live with chronic pain or opt for less effective treatment simply because it was all they could afford.
Gold Coast orthopaedic surgeon Associate Professor Matthew Scott-Young, who represented a delegation of spine surgeons during a meeting in Brisbane with Health Minister Greg Hunt, welcomed confirmation spinal fusion and total disc replacement would no longer be restricted to the top level of cover.
"Minister Hunt assured us that he had listened to our craft group and other stakeholders and confirmed that all surgical treatment of spinal conditions will be available as part of the Silver category of cover under the new rules. Spinal fusion and total disc replacement had originally been restricted to Gold, the top level of cover," Assoc Prof Scott-Young said.
"That is going to make a huge difference to everyday Australians who can't afford to increase their level of cover and were faced the possibility of having to drop their insurance and join the queue in the public system.
"We applaud the Federal Government for listening to the doctors at the coal face on this important issue. Minister Hunt recognised that private health insurance was not just about actuarial tables and financial modelling – it's about people – hard working Australians who have invested in their health by taking out and maintaining the health cover they can afford. These Australians, our patients, will continue to have affordable cover and access to the spine care they need when they need it."
The Spine Society of Australia (SSA) also welcomed the decision to allow access to all forms of spine surgery to patients with both Silver and Gold private health insurance cover.
SSA President Dr Michael Johnson said the proposal to split spine surgery between two tiers of cover would have been a recipe for patient confusion and disenchantment.
"We strongly opposed the clinical categories, which split the care of the spine between Silver and Gold bands, so this decision by the Federal Government is a major win for patients with private health insurance," Dr Johnson said.
Dr Bill Sears, Immediate Past President of the SSA and a Sydney-based neurosurgeon, said the group had strongly argued health fund coverage for spinal surgery should be an all or nothing proposition – you should either be covered, or not.
"Australians who choose to take out cover for private spinal surgery are entitled to feel confident that they will receive the procedure that is best suited to their problem," Dr Sears said.
"Things may change at the time of surgery; patients must be assured that they are covered for whatever eventuates and that their care will not be compromised. Their surgeon shouldn't have one hand tied behind his or her back and that is why we fought so hard on this important issue."
Sydney neurosurgeon Associate Professor Ralph Mobbs said the millions of Australians who have paid for private health insurance for decades – in the face of annual premium increases – deserved to receive the coverage they had been promised.
"Those who have invested for private health insurance for years have a legitimate right to expect the treatments they previously had for the same premium and it is pleasing to see the Health Minister clearly agrees," Dr Mobbs said.
Sydney neurosurgeon, Dr Marc Coughlan, said the proposed reforms in their original form, if left unchallenged, would have impacted the lives of thousands of patients, precluding them from having spinal fusions.
"Many of these people are younger patients with spinal conditions impacting on their ability to walk, work and remain productive in the workforce, so this news should be of great relief to us all," Dr Coughlan said.
Gold Coast orthopaedic surgeon, Assistant Professor Laurence McEntee, said offering spinal fusion only in most expensive level of cover would have triggered a massive cost shift to the state-run public hospitals, with a drastic increase in the number of people moving to the public system for treatment, joining the already overflowing public waiting lists.
Minister Hunt's decision will keep patients with complex spinal conditions in the private system getting treatment from the specialist of their choice.
An estimated 3.7 million Australians have chronic back problems and more than $1 billion in total health care expenditure in Australia is attributed to the condition, according to the Australian Institute of Health and Welfare (AIHW)
In a 2017 report, AIHW found back pain and back problems were the third leading cause of disease burden in Australia.
Sequel PR, Fran Metcalf