West Australians urged to think hard about their health insurance

West Australians urged to think hard about their health insurance

Wednesday 4 November 2015


Have you been sitting at home late at night and the phone rings, only to discover that the caller wants to talk about your private health insurance, conveniently offering you a substantially reduced premium for health cover? West Australians are increasingly receiving such calls as the battle for the health insurance dollar heats up.


As a medical professional, however, I would suggest that if you do receive such a call, resist the temptation to change your policy because you might get a shock when you get sick. More than half of Western Australians have private health insurance, the highest rate in the country. WA also has the best and most substantial per capita private hospital infrastructure in Australia, dominated by the Ramsay Health Care and St John of God Health Care groups.


Unfortunately there have been recent changes to private health insurance that will lead policy holders to question the value of such cover. The landscape was always bound to change with the float of Medibank Private, moving Australia’s biggest private health insurer into for-profit mode. The second biggest insurer Australia-wide is BUPA, a UK-based multi-national with “customers” in 190 countries. In WA, the largest player is the mutual, not-for-profit HBF Group founded in Perth in 1941.
It was inevitable that Medibank Private’s fiduciary responsibility to its shareholders would eventually result in changes to the way it looked after its policy holders who, of course, are no longer its members. The recent stoush between Medibank Private and the Calvary Hospital Group has served to shine a light on the industry as a whole. There are an increasing number of exclusions with different insurers. I would encourage patients to ask questions of their private health insurer, especially those that ring you late at night. Ask them detailed questions. If my baby is admitted to the special care nursery after delivery, are we covered? Does my doctor have to telephone a clerk in the office for pre-operative approval to perform important surgery?


Does my policy cover Bariatric surgery? We have also seen an increasing proliferation of rubbish policies where the fee paid to the doctor is marginally above the MBS schedule fee, which long ago lost pace with the true cost of providing medical services. Policies that restrict care to being a private patient in a public hospital are entirely useless and do not serve the public good beyond looking after the bottom line of a public hospital administrator or accountant. Ask your insurer if such exclusions apply to you. It is a legal and fiduciary responsibility for the for-profit insurers to deliver a dividend to their shareholders. But this must not come at the cost of quality patient care. Recent moves by Medibank Private to label recognised complications of surgery as “mistakes” threaten to change the private medical landscape. If a patient suffers a wound infection or a blood clot, it is not a mistake. It is a risk of surgery.


Not covering readmissions to hospital will lead to a further burden on a public hospital system that is struggling to cope with demand in every state and territory in Australia. No doctor or no hospital would argue against quality care. Year on year, we strive to find new ways to reduce complications, the length of stay, and indeed the need for hospitalisation at all. Fairness and equity are key principles. We must never end up in a situation where doctors or hospitals cherry pick easy cases.
Universality is a principle which should apply to private medical care just the same as it does to the Medicare system. To private health insurance policy holders, I would encourage you to make the call and be choosy.


Taking out a private health insurance policy is the mark of a responsible member of the community. It is not exclusively the privilege of the wealthy. I encourage you to ask the necessary questions. Your health may depend on it.

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