I’m no expert in health economics, but there’s been a lot of commentary over the years from some who are suggesting that the artificial lifeline given to private insurers and hospitals has done just about zip to “take the pressure off the public hospital system”, while nicely fattening pay packets and profit margins for some. At enormous cost to the public purse.
These comments from the Doctors’ Reform Society seem apposite:
Insurers are angry and say 400,000 people will drop private coverage, but Dr Tim Woodruff says they should not expect the current level of tax support to continue.
“I’m not worried about how much whinging they do. [I am] just pointing out that it is whinging because of self-interest, because they’ve got a vested interest in keeping as much money from the taxpayer rolling into their coffers as possible,” he said.
“They’ve got every reason to complain but it’s not a reason that should deter the Government from doing what they’re doing.”
Obviously part of the way the Government will be justifying the adjustments to the Medicare levy thresholds will be in terms of the narrative of asking those who are better off to make sacrifices in the broader cause of combatting inflation, and reining in wasteful spending, but I’d also like to see this decision justified in terms of its health policy rationale. I await Nicola Roxon’s defence of it with interest.
The reason health insurance companies have trouble retaining members has nothing to do with tax or health policy. It has everything to do with the fact that some time during the last 20 years insurance companies forgot that they are supposed to provide, you know, insurance, in return for the insurance premiums they receive from customers.
Instead, insurance companies today receive insurance premiums in return for which they provide:
a) Expensive CBD and mall-located shopfronts, glossy brochures and marketing campaigns to explain the benefits and coverage of their policies.
b) Wages to low-level staff and middle managers to ensnare unwitting members of the public.
c) A raft of disclaimers and loopholes to prevent the paying out of proferred coverage.
d) Fees to lawyers to defend them against ever having to pay benefits.
e) Inflated salaries to executives to maintain the operation of the above.
f) If anything is left over, dividends to shareholders.
Who benefits? The insurance executives, the marketing industry, the lawyers and the shareholders. Who loses? The patient.
It’s not insurance, it’s extortion.
We don’t have a user-pays health system. We have a user-pays-and-pays-and-pays health system. Once with your Medicare levy. Again with insurance premiums. And a third time out-of-pocket when the insurance company fails to provide the promised benefit.
And in another bitter pill for the free-market ideologues to swallow, the Australian market isn’t actually big enough to sustain a viable private healthcover industry. That’s why those companies forever have their hand out to the taxpayer to support them. That’s why in the absence of supportive tax policy, these companies will die. Because the market isn’t big enough and because they deserve to.
Many supporters of private health look to the US for their cues. Well, in America’s heaven-or-hell health system, the reality is that if you’re covered, the quality and extent of care you receive is unsurpassed anywhere in the world. But this ‘heaven’ only results because the market is so large and so competitive that the insurance companies have to provide quality cover and quality care – or they simply won’t have any customers.
Whether ideologues like it or not, Australia is almost structurally bound to have a socialised health system because it’s the only economically supportable model given our population and taxation base.
i’ve looked closely into getting insurance twice this year, particularly with a kid needing orthodontics, and each time it just doesn’t quite seem to justify the expenditure.
As for me and dental…its seriously cheaper to save the contributions go to Thailand.
How can the private insurance moves yield lots of revenue for the private health funds if they don’t work – if they don’t get lots of people to take out private cover and use private hospitals?
That Australians are offered free public health services is distortionary in terms of demand. What is so intrinsically bad about getting wealthy preople to pay their share of health costs?
There are many instances in the economy of public subsidies designed to take off pressure from public goods. A major area is education. Offering transfers to private and church schools reduces demands for public schools and enriches the public school system net since the relief offered to the non-government school is much less than the cost of educating a child in the public schools.
Low income Australians would be worse off in health care terms without private health insurance and without non-government schools. More dollars could be spent on them.
hc, if you really believe that, I’ve got a nice bridge with fantastic harbour views that you might be interested in buying.
There’s no discretionary demand for health care. You get sick, you friggin’ need health care. That is not market distortion, it’s life.
It’s not a market governed by neat Keynesian supply and demand graphs, no matter how hard you wish, or how many times you say it, or how many prayers you mumble to the invisible hand to make it all better.
That’s another reason all the free-market ideas that have been tried in Australia’s health system have been so lacklustre in terms of take-up. Because the system in reality differs from that which the architects of these schemes imagine it to be. If you design a solution to the wrong problem, you get a botched result.
“There’s no discretionary demand for health care. You get sick, you friggin’ need health care. That is not market distortion, it’s life.”
Really, Mercurius?
My GP once remarked to me that half the people in his waiting room shouldn’t really be there.
What did he mean, I asked. Well, he explained, they had minor (or non-existent) ailments that they could treat themselves. Or they were oldies who were basically just there for a chat.
This isn’t to say they were all hypochondriacs, just that people tend to use things carelessly when they are provided free, or almost free, as medical treatment is. I would argue that much (though certainly not all) medical treatment is in fact discretionary and is responsive to price.
And there’s things like pathology tests. If it costs the patient nothing, there’s no incentive for the doctor not to run every test under the sun, including testing 85-year-old grannies for HIV.
Not to say I agree with Harry’s views that private health insurance is a great system; just about everywhere does more efficiently than the United States – including us, despite the myriad inefficiencies in the Australian health system. The only parts of the US system that do work reasonably are the socialized bits, like VA health system for armed forces veterans.
Paulus wrote:
That’s garbage Paulus. There are massive swathes of the community who cost us all a fortune because they *don’t* go to the doctor when they need to. From simple things like infected teeth causing heart problems, early diagnosis of breast and prostate cancers, runaway secondary infections, hearing problems in poorer socioeconomic kids that condemn them to bad education outcomes, that the list goes on and on.
You hear this kind of anecdotal rubbish all the time when commentary starts up about socialised health care (waiting rooms full of hypochondriacs), but the facts are that if people (and particularly men) went to the doctor earlier rather than later, it’d be cheaper for everybody. That and finding a few more doctors.
Paulus, you should revise that last statement to read “I would argue that much frivolous, fake or attention-getting behaviour is in fact discretionary and is responsive to price.”
But actual medical need is not responsive to price. Still don’t believe me? Read on…
This will come as a shock to market fundamentalists. Brace yourselves: bacteria, viruses, cancers, traumus and degenerative conditions don’t know how much they cost too fix and don’t take any notice of the price tag! Egads!
Furthermore, for patients in need, as anybody who has had a serious illness would understand, no amount of money is too much to pay. Health is irreplaceable and priceless. People will keep paying till their last dollar to get well again if they have to, but I’d argue that it’s a very inefficent use of resources to send somebody bankrupt before they’re well enough to rejoin the workforce.
Getting sick and needing care is not responsive to price. It’s not a market, it’s an essential human service.
Why is that so hard for market eggheads to understand?
Which they need to see a doctor to determine whether it’s actually a minor aliment or something more.
Pushing for private health care is going to do nothing to help the poor elderly people who are currently burdening the health system because the age care system is in such a poor state.
In the short term it will quite possibly be somewhat responsive to price. However introducing price pressures will most significantly impact preventative and early detection medical expenditure because this is what is viewed as ‘discretionary’. As preventative and early detection are much more efficient than reactive/curative care, as reduction in spending in these areas will result in a cost blow out in the long run.
There was a story a couple of months ago on the 7:30 Report that gave an example (yes, an anecdote, not data) of how the public system distorts people’s choices. A guy had hurt his ankle playing footy on a Saturday. It was still sore on the Monday, so he presented to his local hospital emergency department. The reporter asked why he had not just gone to his GP. The guy said that he knew the GP would send him off to get an X-Ray, and it was quicker and cheaper for him to show up at the hospital where they would just send him up to the radiology department, rather than his GP sending him across town to a private raidology clinic.
Now the point of the story is that Mercurius is right – people’s need for health services is generally not price sensitive (the dude had a sore ankle). But how we respond to that need can be influenced by price. Having a hospital emergency ward that essentailly doubles as a free (bulk-billing) GP and radiology clinic encourages people to take that option. But from a societal point of view, that’s a waste of resources. The guy just had a bad sprain, he wasn’t in any critical need of immediate medical attention, and he took up valuable ER resources.
Now if the hospital charged him a premium for getting standard GP services in hospital when he could have gone to a GP, he might have made a different choice – a better choice from a societal point of view.
Now the other side of the problem is that there simply aren’t enough bulk-billing GPs out there. Personally, I never have a problem getting an appointment with a GP on the day, but I live close to the city, and I can afford to pay about $30 out of my own pocket. Maybe not the most equitable outcome, but I don’t take up time at the ER.
From a policy perspective, I think the Medicare Surcharge threshold has moved too far up the income scale – maybe raise it to $60k or $70k, but having it at $100k is going to lead to a lot of people (who can afford private cover) dropping out of private health insurance and putting extra strain on the public system. Given that we already have a mixed (public-private) system, this is a bad result for everybody who relies on the public system, particularly the old and the poor (who btoh tend to be sicker than the young and wealthy).
“And there’s things like pathology tests. If it costs the patient nothing, there’s no incentive for the doctor not to run every test under the sun…”
And if the cost is borne by the patient, there’s still no disincentive for doctors. And if the cost is borne by doctors, they’ll pass it onto the patient.
If doctors are irresponsible in their use of resources, that’s not going to be fixed by upping a fee.
d
Should anybody be in doubt about the market failure in the US here’s a recent article discussing per-capita spending on health and life expecancy for selected countries.
And for visual impact the associated chart http://ucatlas.ucsc.edu/health/spend/cost_longlife75.gif“
What David Rubie said above. I’d rather see people ‘overservicing’ themselves, rather than waiting to see a doctor until the problem becomes serious. It takes a many more resources to fix the serious problem than the minor one it may have been if caught early.
It can also take a lot of pathology tests to work out what a problem is. I’d rather have the overzealous GP, thank you.
One of the major costs in the health system is the labour – doctors and nurses.
This is the first crack at doctors fees. Under the current system the health funds have no incentive whatsoever to be controlling one of their major outlays – doctors fees.
It’s my impression that earlier this year the funds were given at least two tasks –
1. set up a peak body who’s first job was to educate the public about what the margins and workings of their business were – this was mildly successful (I heard about it…anyone else?)
2. devise a system to put pressure on costs (bzzzz, fail)
In the absence of self regulation, real regulation is being attempted.
Now in the Rudd ‘business as usual’ system this supplier (the funds) will sink or swim on merit. also, there’s both policy and penalty going on here to show the funds that Nicola is serious after they took her for an embarrassing ride earlier this year on the price increase. ‘Get back in your box’ would be a nice way of putting it.
Who’s going to fund the FOI case for finding the treasury document that shows less cost to the taxpayer in 12 years time when the funds are gone (virtually or totally)?
“That Australians are offered free public health services is distortionary in terms of demand”
It’s only free if doctors bulk bill. If they charge, then the patient pays, and only gets part of that payment back as a refund from Medicare.
It ain’t free, somebody has to pay, no matter what.
A system where lots of people get health care free, whilst others have to pay a serious amount of money (also known as “medicare”) is indisputably most unfair.
Well yes that describes the problem pretty well. Most people want whatever it costs to investigate or fix a medical problem if the probability is very low – and all at once rather than progressing from most likely to least likely. However, whether we like it or not, the health system does need to work out where to allocate resources best rather than assuming there is an infinitely big bucket of money.
Re: the changes to medicare, I would have much preferred they used a larger stick (increase the surcharge) and remove the carrot (the 30% subsidy). This would raise more money to put into the public health system, rather than just give the middle class another tax cut. But then I suspect this is more about ideology rather than fixing anything
What I would like to see is some reporting on what percentage of health fund payments goes to payment and what is taken up in overhead or profit (similar to what you see for charities).
I disagree – you don’t need to take out private health insurance. If you don’t you might end up paying the surchage, but then if you use the public system instead of the private system you’ll be costing the community more anyway, so if you’re capable its quite appropriate to pay higher taxes.
How much infrastructure does the private system pay for?
To my mind as someone who can afford private health and does take it out I am quite happy to pay taxes to pay for people who genuinely cannot afford proper health care, eg Pensioners, unemployed etc and it needs to be of a good standard. No luxuries, but those people need to have reasonable surety they will get a good outcome. However I see no reason why I should pay larger taxes for those who CAN afford private health and CHOOSE not to take it out.
To my mind where Swan really got this wrong is if the medicare surcharge was costing the lower income end say a $1000pa then he would have been better off to give them a $1000 rebate NOT tied to their being a health fund member. That way it puts them back in the same place in terms of their family budget but does NOT give an incentive to drop private health. Social justice achieved and no additional pressure placed on public health system
Mercurius,
People that err on the side of markets only do so where there is an opportunity for actual markets to exist.
Many therapies are under exclusive patent (ie monopoly) and thus frequency of occurrence makes no pricing difference whatsoever. Once said patent expires, there is opportunity for price reduction based on competition. However, given the pace of medical research, this often means that the price reductions take effect once a therapy has been removed from the PBS because it has been superceded by a superior therapy.
To presume that big pharma don’t take the PBS subsidy into account in their pricing policies is foolish. I am not sure that there is a practical alternative though as to remove essential therapies from the PBS would be overly expensive for patients. I would hope that big pharma are pumping their funds back into research for new therapies – although sometimes this can be difficult to quantify.
One of the biggest scandals in public healthcare is the extent to which big pharma run clinical research on public health patients without footing the medical bill for the health costs incurred – instead they pass it onto the public purse. Private hospitals demand that big pharma pay for every last cent of cost incurred, but unfortunately public hospitals seem unable/unwilling to do so. Given that a significant amount of this research involves elective procedures, it really is quite a scandal.
SATP, if you don’t want to pay any more than you already do in taxes and medicare levy, you can always go to a doctor who bulk bills.
Mercurius, reading further back:
“The reason health insurance companies have trouble retaining members has nothing to do with tax or health policy. It has everything to do with the fact that some time during the last 20 years insurance companies forgot that they are supposed to provide, you know, insurance, in return for the insurance premiums they receive from customers.”
I’m not sure this is correct or easily verifiable. My experience working in Health Care is that people leave Health Insurance funds because they are too well and generally see no need for it. I think the raising of the medical levy will also provide a bit of extra motivation for young-ish, healthy people to leave Private Health Funds come tax-time. The effect of this exodus will probably be felt in the coming 10-20 years as more Gen X-ers seek elective procedures. Mercurius, my information was that rates of membership of Health Funds had largely stabilised over the last 5 years. I would need to check that to confirm though.
Further, Mercurius says:
“And in another bitter pill for the free-market ideologues to swallow, the Australian market isn’t actually big enough to sustain a viable private healthcover industry. That’s why those companies forever have their hand out to the taxpayer to support them. That’s why in the absence of supportive tax policy, these companies will die. Because the market isn’t big enough and because they deserve to.”
I’m not sure what the Private Health rebate (or any government rebate!) has to do with “free-market ideology”. The original purpose of the rebate was to encourage those who could afford (with some government top-up) to utilise private health to do so in order to reduce demand on the public system. There are many legitimate ideological battles to be had between free-market & regulated service provision. I’m just not sure how this battle applies to the Australian health care system! When the government part subsidises private service provision, this does not equate to the imposition of free market ideologies!
Partially true. If they really believed in the free market, they would’ve let the commercial health funds fail without the rebate. Maybe Rudd is more of a free marketeer than Howard was!
But I think what the former government believed in was ideologically-driven. Their ideological script told them that ‘markets are Good and will Fix Everything’ and they weren’t about to let inconvenient truths such as Australia’s market being too small to trammel their ideology. So what they set up was not a real free market, but a cardboard cut-out of a free market. Sort of like those wild west Hollywood sets where the buildings are painted on the front of wooden boards, propped up behind with sticks.
When a government uses taxpayer money to prop up commercial enterprises in a market that isn’t viable due to structural factors (ie not enought people!), well I think on any reasonable definition that counts as an ideological act. The former government were incapable of recognising the reality before them because it didn’t accord with what their ideology told them Must Be The Case.
The “free-market ideology” comes into it when you consider it would have been more cost effective to spend that money on the public health system rather than spend it on the rebate. Most of the cost of the rebate is going to people who were already in private health insurance anyway. The cost of the 30% rebate plus the gap in medicare levy is much more than the marginal saving (25% of scheduled fee) of the number of people that shifted to private health insurance (~10%). The numbers make no sense, so it can only be the blind ideology (private > public) that backed the policy.
Ayup. I finally took out good (as distinct from minimal) private health cover when the husband of a friend was diagnosed with cancer and had the life-saving surgery within a couple of days, but not before they’d been told by the surly but effective surgeon that if they’d not had private health cover then he (the husband not the surgeon) would have been told, though of course not in so many words, to go home and die.
But even now that I fork out vast sums every three months, I still can’t get any kind of treatment or consultation without turning my pockets inside out.
Mercurius,
“When a government uses taxpayer money to prop up commercial enterprises in a market that isn’t viable due to structural factors (ie not enought people!), well I think on any reasonable definition that counts as an ideological act.”
Which/what market are you talking about? The only markets in Australian Health Care are the competition between PRIVATE medical clinics for patients and the competition between PRIVATE hospitals for patients/ highly regarded specialists. I’m not entirely sure how/what effect the private healthcare rebate had on these markets or even how would would go about quantifying such an effect. Is there any evidence whatsoever that the purpose of the private health rebate was to “prop up commercial enterprises’? I’m pretty sure the purpose was to reduce patronage of public hospitals! Exactly what this has to do with “markets” is completely beyond me! The debate about “public” vs “private” is not NECESSARILY cognate with a debate about free-markets vs regulated transactions.
Desipis says,
“The “free-market ideology” comes into it when you consider it would have been more cost effective to spend that money on the public health system rather than spend it on the rebate. Most of the cost of the rebate is going to people who were already in private health insurance anyway. The cost of the 30% rebate plus the gap in medicare levy is much more than the marginal saving (25% of scheduled fee) of the number of people that shifted to private health insurance (~10%). The numbers make no sense, so it can only be the blind ideology (private > public) that backed the policy.”
I’m sorry Desipis, but I really think that you completely misunderstand what belief in markets actually is. Belief in markets is not about preferring public to private, it’s about believing that where markets exist, they tend to provide a more efficacious and efficient service than a regulated service-provider. Many private ventures are not free-markets in the sense that there is genuine competition for the provision of services. If you read what I wrote above, I argue that the Australian Health care system taken – inclusive of public and private prividers – has never been a market.
By all means, oppose government subsidy of private providers. But please try to understand that people that believe in free-markets and people who believe in government subsidies ARE NOT NECESSARILY THE SAME!
I read nurses are hoping for the right to write prescriptions. I regularly go to the doctor for prescription renewal, they’re written for a limited time period. Like so many oldies it’s blood pressure, it ain’t gonna change soon. A registered nurse is capable of taking blood pressure measures, renewing a prescription or passing me to a doctor if it were to rise.
Chatting to a doctor is not my choice of good conversation! and the wait pains my arse no end.
I don’t believe the BS about people seeing a doctor to chat, it’s prescription ritual driving them.
Nurses would love more authority, they carry out the existing duties in my experience very well.
fluff4
My recent experience of GP surgeries (three different ones in inner city Brisbane) makes me highly sceptical of the “chat to the doctor” meme too. If you’re in there for more than 3 minutes you’re doing really well, and that’s usually after a wait of an hour after the scheduled time, and the standard price for a quick consultation in these parts is $62, for which the Medicare rebate is $32.
Quite. I’m often tempted to say ‘That was a billable hour, you know. By sheer coincidence, I charge $30 an hour.’
Mark,
I think it depends on the doctor. A few years ago I had a doctor who used to insist I make a separate appointment for esch ailment I wanted to see her about (eg cancer injections, arthritis, chest complaints) even if that meant I had to come back over several weeks. The two doctors in the practice I go to now treat all my illnesses at one consultation,plus any new ones, plus renew prescriptions when necessary.And they bulk-bill.Am now very impressed and satisfied.
Paul, if you were living in Brisbane and you could find a bulk billing doctor outside 24 hour medical centres where you’d be lucky to get two minutes, you’d be doing very well indeed.
Not sure if I understood your last comment, Mark, but there are actually bulk billing doctors in Brisbane. I sometimes go to the one at Fairfield Gardens if all I have to do is renew a prescription or get a doctor’s certificate.
…And if so, that purpose was based on an ideological assumption that private organisations would do a better job of providing healthcare than a government provider. Little wonder, since they could inflate their premiums by 30% thanks to the government’s generosity with taxpayers’ money. All of which looks exactly like propping up a commercial enterprise to me.
To be honest, I’m not sure what the purpose was, but the effect was most definitely to prop up commercial enterprises, and it sure didn’t reduce patronage of public hospitals. So on any account, it was either a failure of policy or a nasty bit of ideology, or, as I think, both.
Sorry, but as a GenXer, I’m genetically incapable of believing anything the government tell me. You’re not a Y-er by any chance, are you?
Tell you what, after I sell the Harbour Bridge to hc, I could broker you an excellent deal to buy it off him second-hand at half price – plus my commission, of course..!
frank luff,
Nurses doing drug prescription would be a major jump in duties, liabilites and expectations which many nurses would be unwilling to take. A similar system occurs in the US with a fair amount of research showing that it does not necessarily lead to better healthcare outcomes in terms of either ongoing patient care/management or patient satisfaction. In terms of pricing, I can guarantee that nurses would make a substantial wage claim for the addition of drug prescription duties to their list of responsibilities. Also, please bear in mind that we have a massive shortage of nurses in both the private and the public systems!
Mark,
It’s hard to quantify the “go to the Doctor for a chat” thing. Certainly it’s more noticeable amongst veterans and wives of veterans. The really noticeable factor though is the amount of visits which could have been reduced with lifestyle/dietary/educational intervention! For some specialists this is reaching such a critical point that an increasing number will simply not see patients in the private system who still smoke regularly despite repeated warnings or refuse to alter their dietary habits prior to surgery and seek the necessary psychiatric/psychological counselling for excessive-eating disorders. Obviously these individuals unfortunately just bounce over to the public system.
Although I don’t go to the doctor because I’m bored (if anything I should probably go more regularly), the last two GP’s I’ve had (one only for a short time, the other over a period of 7 years) have been quite chatty and would always be in there for more than just 3 minutes.
I agree waiting periods can be a real but then the places I’ve been to have been happy for people to ring beforehand to see how late they are running – and given that most doctors attempt to fit in more urgent cases at the last minute, its understandable. At least you can get the medicare rebate straight back now via EFTPOS rather than ending up with a big pile of receipts that get lost.
I realise that government subsidies don’t make a free market, but what other rationale is there to drive towards a private system other than the supposed benefits of a market based solution?
Mercurius,
I’m a cynical Gen X-er too I’m afraid. So cynical in fact that I’m unconvinced by statements like “xyz represents an ideological attack on such-and-such public service”! Like you, I’m cynical of governments and what they tell me – which is why I believe in markets!
Again, I’m not sure that the purpose of the rebate was an: “…ideological assumption that private organisations would do a better job of providing healthcare than a government provider.”
I think a more likely assumption was not neccessarily that the private organisation “would do a better job” but rather that it would reduce uptake of public services.
Sure as a Liberal I think that private services tend to be better than public services. However, this would be a positive externality of burden-shifting rather than a primary outcome. This is a distinction here that I think is really important to highlight!
rosie, there don’t appear to be any bulk billing doctors in the Valley or New Farm.
Maybe I’m naive, but I’d trust the government over an insurance company’s marketing department any day.
Desipis,
“I realise that government subsidies don’t make a free market, but what other rationale is there to drive towards a private system other than the supposed benefits of a market based solution?”
It’s called cost-shifting and governments love it because they think it will be a panacea against raising taxes to fund a greater uptake in usage of public services.
Certainly I think private hospitals shit all over public hospitals. But what would fix that? Government money? How much more money? Once money is injected, how do we keep costs (doctor/nursing/allied staff wages) low? How do we stop “rich freeloaders” taking up spaces that should on social justice grounds be reserved for “working families”? Personally I am very sceptical of the ability of governments to ensure positive public service externalities – no matter how well funded the public service is! Given this, until the day I see an excellent public health facility, I will scrimp and save so that I can go private!
Desipis,
“No child will live in poverty…”
“This is the recession we had to have”
“We will have a treaty with indigenous Australians”
“There will never be a GST”
“There are weapons of mass-destruction in Iraq”
Insurance company marketers may suck but at least Insurance companies can be held to account in the courts for breach of contract. However, it’s been well-establised in the Australian Legal System that governments can’t be held accountable for election/policy promises upon which the electorate relies!
Agree with all Mercurius’ posts here, absolutely.
Why on Earth would anything think that privatised healthcare would be efficient or ethical, at all?
Consider:
1. People do not choose to fall ill or get injured. But once this has happened, they want fixing, as fast and efficiently as possible, at as low a price as possible.
2. Private businesses exist to make a profit. If they are publicly listed, they are legally required to prioritise the interests of their shareholders above all else. Hence, they need to charge as high prices as they can, acquire more customers, minimise infrastructure/maintenance costs, and so on.
If the business paradigm is properly applied to healthcare, then private health providers should be making people ill, overprescribing, overcharging for treatment, and running down clinics and hospitals, while private insurers should be charging as high premiums as possible but using every feasible loophole to avoid payouts.
Any competing provider that behaves better will be driven into the wall, so for the patient, there will be a “choice” between near-identical evils.
This is clearly not a sane way to provide healthcare. Why bother pretending at all that a “market” or for-profit system is in any way advantageous over government-run single-provider?
Nationalise the whole damn lot, and charge an appropriate Medicare levy.
A few points here in the interesting discussion:
- my own (admittedly limited to childbirth) informal data collection suggests people who went public actually got better health outcomes (doctors always on hand, good midwifes on roster, 24 hour anaethistist not playing golf, teaching doctors are all in public system) – but worse accommodation afterwards (ie public rooms suck). Suffice to say, the jury is well out on whether private healthcare is actually better health wise. However, yes, your room will be nicer.
- There was a study some time ago (i wish I could find it) which noted that 4% of public funds went on administration, and 14% for private. ie private is, on some scores, woefully inefficient on basic measures. Admittedly that would include returns to shareholder,s I guess – but that just means one in seven health dollars doesn’t go to “health”.
- We dont really have a public v private system at all, but a bizarre cross breed. Thus, your average “private” health consultation gets public monies in several ways 1: medicare rebate; 2. 30% insurance rebate, and sometimes 3. its contracted to a public hospital anyway – thus EXTENDING public waiting lists, rather than the opposite. I dont have the slightest problem with number 1, since it meant to be universal – but 2 and 3 annoy me on public policy grounds
- On waiting lists, you can bet your bottom dollar that if there was *any evidence at all* of private take-up reducing public waiting lists, the last government would have adduced it publicly, avec trumpets. They didn’t. By contrast, several studies debunk the myth, noting that the punitive surcharged system merely led to minimal cover uptake, which doesn’t do anything to elective surgery lists.
- Finally, just looking at public policy: how much of the 30% of public money (for allegedly ‘private’ subscribers) has effectively been flushed down a toilet after premium rises? Where ’s the public value for money? It must be down around 10% instead of 30% by now in terms of actual health impact – having just been an enormous boon for insurance companies.
Oh the naivety of healthy people. Bless. I used to think that private health insurance was a rip-off, until I developed a huge kidney-stone that couldn’t be removed first-go. I then discovered that anything other than ‘you are about to die right now’ – including severe and debilitating but not life-threatening pain – is considered elective. Oh the horrors of the public waiting list. Now I have private health insurance.
But having just watched Sicko, I thank God will still do have Medicare and I ‘choose’ to have private health insurance so that I never have to suffer three months of severe and debilitating pain on a waiting list again.
(In my sorry case of woe, I forked out $4000 of my own cash as an uninsured patient paying for a private procedure that actually didn’t end up working anyhow, and I was back on the public waiting list but with a $4000 hole in my pocket.)
Never take your health for granted peoples.
It would be wrong to make the assumption that treatment in a private hospital comes without cost aside from the insurance. When I had an operation at St Andrew’s in 2004, I was out of pocket around $2000. The insurance didn’t cover the fees of the surgeon and the anaesthetist (I had to pay the substantial gap between their fees and the medicare schedule) or for that matter the gaps between specialist appointments and radiography and the medicare rebates. All the private insurance covered was the $500 a night for the hospital itself. Then there’s medication, etc.
I have only a couple of points:-
the medicare levy has been a bone of contention for me as a lesbian. As my income is over $50000 but the federal government refuses to recognise I am in a relationship with a dependent partner, I am meant to pay the toll for not having taken out private insurance. I have therefore on my last 3 tax returns simply not ticked the box to declare the sex of my partner, whilst faithfully providing all other details – her age, name, income etc. I’ll cop not getting several thousand dollars of tax return back because I can’t claim her as a dependent partner, but I draw the line at paying more tax on the basis of the government declaring our loving relationship either doesn’t exist or isn’t valid.
So from a purely personal selfish point of view, at least this change will mean I will no longer have to refrain from giving the ATO information.
As for the private health/public health system here, while I’m too lazy to go google and provide links, my memory is that every major study into the effects of provding the dis/incentive for wealthy Australians to get private health insurance has failed spectacularly to reduce pressure on the public system. In fact, I know down here in Tas it has exacerbated it, with privately insured patients being able to ‘queue jump’ (yeah probably not the best slang term) into public beds to get treatment ahead of more acute uninsured patients.
The whole thing is a big con. I self-insure personally. But I can say I would gladly pay more tax towards an improved accessible public health system for everyone. If France can do it, why can’t we?
I agree with AndyC when he wrote: “Nationalise the whole damn lot, and charge an appropriate Medicare levy” but until that time, I’m a member of a not-for-profit health insurance fund) I could never go through that pain again.
Antonio @ 41 “Certainly I think private hospitals shit all over public hospitals.”
Are you talking from experience? As a big user of medical services (both private and public) over the past few years as a result of cancer and other serious illnesses, there is no doubt in my mind that the public system ’shits’ all over the private system.
I might have been lucky, but I certainly have the distinct impression over that time that specialists in the public system were far more caring than many of the private specialists. Perhaps doctors in the public system are more ideologically-driven towards patient outcomes rather than doctors incomes.
Wow Andyc,
I have a revelation for you. Many/most of the most talented specialists are in private practice. (Similarly, most of the best barristers are in private practice!)
Can you be an ethical nurse/doctor and be in the private system? Absolutely!
So why would talented people go private if they are ethical people? Because the facilities are better, the organisation is less-bureaucratic, shit gets done and you are remunerated appropriately.
Nationalise the system and the talented specialists will go the big US private hospitals where they are remunerated for their time appropriately, they have decent equipment, they are staffed appropriately by well-trained support staff, they can conduct private research and they don’t have an endless stream of government forms to complete.
Andyc, look into the history of medical research and discovery. Very little of it happens in countries with completely socialised medicine. Why not, what’s the motivation for innovation?
Public healthcare certainly has an important place in a humane society but socialised healthcare doesn’t necessary lead to better outcomes and private providers aren’t necessarily inhuman vultures. Moderation in approach and a mixed system with choices is important!
As for the public system being ethical or efficient – well I just printed out your comment and put it on the wall of our lunchroom here at one of the private hospitals I work at. First comment from one of the orderlies – “if public is so great, try f**king working in it!”
Oh dear…
Sublimecowgirl has the Free Marketeers reponse: “cheaper to save the contributions (&) go to Thailand” …
Considering that chances are good, (and getting better) that the thai (malaysian/indian/chinese/whatever) dentist/medico was trained here, (and ain’t it grand that education exports are our 3rd biggest export industry, eclipsed only by iron ore and coal) it’s a pretty good percentage bet that the service standard will be acceptable. It’s a hell of a long way to go for a broken arm tho, and very carbon unfriendly.
Solution: bring PriceIsRight thai/indian/chinese/whatever medicos here, sort of. Lets build a few Hospital Ships.
On land, Bovis, Hassell etc will be extracting 1.23 billion from taxpayers to produce a lousy 750 beds, whereas mercyships new “Africa Mercy” (six operating theatres, 78 hospital beds, state-of-the-art equipment) delivers at half that per bed price: for the same spend, we’d get twice as many beds, which is about what we need in the next 30 years. The ships have at least a 30 year operational life, on par with that of the old PA hospital for example. I doubt the new PA will be there in 30 years time, the design was outdated before it was even up: central water garden ha ha ha, it’s an ugly pile of rocks with pipes sticking up. Got a lot of aluminium cladding bought but, likewise the new mater, funny about that.
With hospital ships you could have a bit of a cruise holiday to go with your bypass, and as long as the good ships of the Girtbysea line aren’t legally part of australia (within the self serving clutches of the AMA and medical Colleges regulatory regimes), it could take advantage of better bang per buck overseas ( or even on the seas) trained doctors.
Too easy.
Public health waiting list are horrendous and anyone with the a serious complaint and the financial means will pay to have treatment done privately.
I wonder how many Australians are now involved in “medical tourism”? I know a few who have gone to VN for dental work.
But why are public health waiting lists horrendous? Surely the enormous diversion of federal resources into private health – some billions of dollars a year – has something to do with it?
You haven’t done the math, have you? Divide those billions by the number of people in private health insurance then compare it to the billions spent in the public system divided by the number of uninsured people.
Left E said:
Is this actually correct? My understanding is that in most cases the public hospitals have the facilities available to do extra operations, they just don’t have the budget to pay the doctors/nurses and whatever bits and pieces they use up. So when a privately funded patient goes into a public hospital it doesn’t affect the public waiting list at all (except potentially remove someone from the list)
In some cases this is actually much more important than you might at first think – having recently spent quite a bit of time with a relative who was very very ill, the privacy and very flexible visiting hours as you weren’t disturbing other patients was greatly appreciated.
andy said:
Well our GP system is private healthcare. Do you think it would run better and be more ethical if the government closed down all the privately run doctors clinics, employed them all on a salary instead and opened up government run operations?
Mark,
Nope no Bulk-Billers in New Farm/Valley. You probably need to move to a marginal seat for that!
Lefty E,
I saw that study too. There was some debate about what constitutes “administration” in the public health system and the extent to which accounting methods in the public system mask or redistribute administrative costs across or up the chain. My understanding is that public hospitals are not costed as discrete entities unlike private hospitals. I could be wrong though and would be happy to be corrected…
When you say:
“We dont really have a public v private system at all, but a bizarre cross breed. Thus, your average “private” health consultation gets public monies in several ways…”
I largely agree with you although it does depend on the intervention/nature of the consult. This is why I was bemused by Mercurius’ denunciation of the move towards “free-market” healthcare in Australia!
Further, I agree with you that the government subsidy for private healthcare doesn’t seem to have affected waiting lists for (I presume you mean) most elective procedures. I’m not defending the policy but rather trying to properly deconstruct the purpose of the policy.
Mark again:
Yeah absolutely people should be prepared for the funding gap in private healthcare which the Private Insurer may not cover due to various reasons (age, health habits, length of time on policy, nature of intervention etc…).
Myriad:
Yeah the discrimination for queer couples with the rebate is f**ked up and should definitely change.
Rodney:
Yeah I work in private health and have seemingly spent half my life in the healthcare systems with severe allergies. There are very few specialists who can treat my condition in Queensland so I’m often forced to endure the 11th hell that is our public hospital system. So I have both a personal and ideological aversion to the public system. That said though, I am happy to spent my own money on my private health.
I’m sorry, mel, that doesn’t make any sense to me. It appears to assume a fixed cost of “health” per individual whereas surely what we’re talking about is the cost of infrastructure and staff.
There are four things I wanted to add about the private health system.
First. Do NOT go to a private hospital if you are really, life threateningly sick. They are very pleasant, the food is nice, everyone is polite but they are not tooled up for it. For instance, you are lucky if there are any doctors on site after hours at all. Private hospitals are set up for surgery and minor medical ailments, not emergency care. I would suggest whichever is your largest, central teaching hospital. PC, that surgeon was, to put it frankly, full of it.
Secondly. The majority of private doctoring happens in an outpatient setting with absolutely no benefit coming from your health fund. I am extremely impressed that anyone can run a clinic on a bulk-billing basis as a GP, virtually no-one can do it as a specialist physician. We are too damn slow. So we charge.
Thirdly. People finding themselves as simultaneously patient and consumer end up buying silly things. There are few people with the knowledge to even approach the informed status required for an economic relationship and, when one is sick, the last thing you want to be doing is suspiciously negotiating with your doctor. You just want to be looked after and have everything done. So you end up either wanting silly things or just saying yes a lot. Real temptation to do something low yield but reasonably harmless and lucrative for the doctor and the hospital in that. So the insurer steps in.
Fourthly. Because of this, private health insurance does not mean you buy the health care you want. It is, as mentioned, virtually impossible to be in a position to figure out what you want in the first place. Instead, you pay for a third party to buy your health care for you. Now, Australian insurers are fairly benign, mainly because the public system saves them from expensive diseases, chronic illness and really sick people. Still, there is always someone paying for the service apart from you. To my mind that is a role for which government is better suited.
And, to preempt the more rabid among us, yes I would rather the NHS than the Cleveland Clinic.
My insurer doesn’t cover any gap whatsoever, Antonio, which is probably why it’s relatively cheap.
Personally, I’ve paid for private medical care out of my own pocket when required (dental and major surgery) and while I’m not ‘over the hill’ yet it’s been cheaper over the course of my life than paying anything to a fund. You’ll find that if you discuss this with your ethical doctor or radiologist you get a very different price than if you elected to have the same procedures done through private insurance.
And there’s the rub – the insurance companies have been revealed to me to be little more than an inflationary middleman, and there’s no control on that behaviour in the system at present.
The idea that you can pay money to a fund with little certainty as to your out of pocket expense at the end of a health event not only dissuades people from joining but it’s a major cause of people leaving too. The term “insurance” is blatant deceptive marketing IMO.
That’s what I’m trying to get at, onimod. I suspect that people are aware that with dental procedures, etc, they will only receive maybe about 50% of the cost back from private health funds. I’m not so certain those who haven’t used private cover for surgery realise the story might be much the same with that for a much higher out of pocket expense.
I think thats being a bit unfair. Have had first hand experience of specialists turning up at 9pm or even 11pm night after night. Seeing them back again at 9am in the morning sometimes was quite a surprise too.
And not a regional hospital either. I’ve been told if that I get sick in Canberra I should if at all possible get to a Sydney hospital – not an issue of ethics or intentions, just that in the smaller hospitals the doctors don’t get as much experience.
Dr. S the friends and family I have who are nurses all the same thing. If you’re really ill, to a large, public teaching hospital.
But that’s not the same as having doctors there 24/7. Some smaller private hospitals just don’t have that at all.
Chris- Yes, we will trundle in if called but if I live 25 minutes away then that may be the length of time it takes before you are seen. There are a number of illnesses where that is dangerously long. Most of us don’t refer or admit patients to private hospitals who are likely to get bad quickly. There are some private places that are set up for very sick people with intensive care staff on site but those are the exceptions rather than the rule. Also, sick people are less profitable than elective surgery and, given the public system exists, most private hospitals are not designed for them.
Also, in my experience rural and regional hospitals are pretty good. It is the outer suburban ones that have the most difficulties. Largely because country towns are nicer places to live than the urban fringe, I suspect.
Mark said:
“My insurer doesn’t cover any gap whatsoever, Antonio, which is probably why it’s relatively cheap.”
That sucks Mark. Perhaps with your recent documented health battles you should consider upgrading on both your health insurance and your auto-immune system!
Seriously though, I would strongly recommend that people carefully understand their private health policies and exercise their right to switch funds if they are dissatisfied with the options. There is a fair amount of competition among the various health funds (and I think it might also increase with the lifiting on the Medicare surcharge) so it can pay off to keep regularly appraised of the various offers.
For instance, when I was recovering from surgery, nurses decided that I might be in danger of getting pneumonia, and I was put on oxygen. I didn’t see the surgeon who’d operated on me for some days (which also incidentally might have earned the hospital a few more multiples of $500, because his say so was needed to discharge me). I think that if I’d taken a real turn for the worse, they’d probably have had to bundle me into an ambulance and take me down the road to the RBH.
Antonio, I suspect giving up smoking would solve both health and financial woes for me!
Dr S, I was hoping you’d turn up in this discussion. I was about to post to the effect of your first paragraph, but you beat me to it. In my home city it’s fairly common knowledge that if you’ve been mangled in an MVA or have something life-threatening wrong with brain or heart then the main public hospital is where you want to be (as long as you don’t mind dust bunnies under your bed).
Am very glad to hear the surgeon was full of it, but am nonetheless not letting go of my private cover till the whole health situation gets better than it is at the moment. Which is not to say I don’t thank God I’m not in the US.
That’s kinda my position too, Dr Cat. The one thing the private hospital cover did do was enable me to have discretion over the timing of the op.
In my situation, I turned out to be in a worse state than they’d anticipated when they did the actual op, and that’s where I was probably lucky that I didn’t get any worse while in hospital, because I’m not sure they were adequately prepared for anything other than a straightforward recovery from straightforward keyhole surgery.
Props to the nurses though – they were ace.
Mark,
I have heard some similar stories about St Andrews – which was really originally designed as a Vet hospital.
Might have been a better plan to have gone to the Wesley instead!
I would generally recommend that in the event of an emergency that larger hospitals are the go (whether public or private). That said, it does depend on the nature of the medical emergency.
Oh sure I agree – I just thought it was a bit unfair to tar all private hospitals with the same brush. It can be really hard to find a doctor at public hospitals sometimes too! I went into emergency once at one (public) hospital at 5am and was told I’d have to wait until 8am when the doctors arrived – presumably if it was life threatening they would have found someone and at least they were able to give me pain relief straight away.
Well I support higher sin taxes
Raises money up front and saves the healthcare system money in the long run.
I think the choice was made by the surgeon, Antonio, but as someone pointed out, it’s hard to remember because generally you’re not in a very good position to make choices when you’re really ill!
Chris, I think a lot of this – in both public and private hospitals – really reinforces the nurse practitioner agenda.
Yes, this was a critical care unit. Was very pleasantly surprised by how well it was set up, especially for family to be able stay around compared to the public system ones I’ve seen – though my experience is thankfully very limited.
“I suspect giving up smoking would solve both health and financial woes for me!”
Possibly, although the psychological and physiological stress caused by quitting may in the short term may lead to a greater incidence of illness. There is also an emerging body of evidence linking nicotine consumption to lower rates of Alzheimers.
Other things to consider include amount and regularity of sleep, dietary consumption (green leafy veges, fruit, minimise dairy and red meats, increase fish oils, increase monounsaturated fatty acids – avocado, nuts, olive oil, glass of red wine per night etc), increased exercise and a decreased stress load.
You know that this is all adding up to you finishing your PhD and earning a decent living! It’s a health issue man!
Just think of the fantastic private health fund package you would be able to afford then!!!
Absolutely, Antonio, with that fabulous Lecturer B salary! I will try not to spend it all at once.
The social justice grounds should be handled by how the system is funded (i.e. tax levels) rather than how it is used. I don’t see any social justice problem with having “rich” people in the public system, with the private system being for those who want to pay more for non-medical benefits (private room etc). If there’s not enough resources to handle demand then increase the funding to the system (directly and also to ensure the training/manufacturing/etc systems are adequately increased as well). If there aren’t enough doctors or nurses to treat everyone that wants treatment, I’d rather these services be allocated on a medical needs bases rather than on who has the most money to spend.
Theoretically. And that’s assuming what’s in the contract fine print bares any resemblance to what’s in the glossy brochure.
Yes, a Dr friend of mine (well, a real doctor, MD, I mean) pointed out to us that all the teaching hospitals are public. So the person who trained your specialist is there a lot of the time!
Now, anecdotal evidence is admittedly limited, but our story was apposite, and hardly uncommon: at 3am on a Sunday after 10 hours labour Ms LE needed an epidural. She needed it fast too.
*Bing*: its a public hospital, therefore Dr Anesthetist is there about 10 seconds later, Johhny on the spot for the surprisingly complex procedure.
The midwife told us we would have waited 2 hours minimum in the private hospital.
Mark,
I gave up cigs one year ago and I gave up alcohol as a New Years Eve resolution last year. I feeling much better as well as richer!
I suspect I don’t need the added stress on top of trying to finish a PhD, mel, but I’d certainly like to give the cigs away when life is a bit calmer!
That’s the other thing I like about the changes to the surcharge: self-insuring is a lot more economically practicable now for a lot of people. I liked whoever said “inflationary middlemen” about the private insurance companies. Spot on!
And the Howard government were effectively bagmen for private health; heavying middle income earners with a stick, ironically labelled “teh choice”. I’m glad those days are over!
Back on topic, while the rebate for folk with private insurance saves the taxpayer money, I think there are probably better ways to improve the health system at a reasonable cost.
One idea that has been getting some media attention in recent years is giving nurses, or specially trained nurses, responsibility for some tasks currently performed by doctors. Not surprisingly doctors are strongly opposed to the idea but I think it has plenty of merit.
The private insurance rebate has done little if anything to ease demand pressure on public hospital waiting lists and has largely been a waste of $. If those monies were tipped into increasing capacity in the public sector there would have been a substantial redcution in waiting list numbers.
Most medical professionals work in a mixture of private and public work. Most surgeons and proceduralists work in private practice consulting (their rooms)and public practice consulting (outpatients in a public hospital)they also operate in private practice (private hospitals and private lists in public hospitals) and public practice (public lists in public hospitals)
Most people who know about how the system works (eg Professors of Medicine and medicos generally)always go public when it’s important and urgent and life threatening and private when it’s not life threatening and a time is needed to fit with work or pleasure. The lack of a cranked-up back-up service with adequate numbers of staff , ICUs, seniors available and throughput numbers in most private hospitals is a reason not to go private in a a private hospital if its life threatening. Going private in a large public hospital is ok.
Surgical Tourism (its always surgical not medical) is not such a great idea. It can be genreally said that the actually surgery, whilst expensive here, is not neccessarily the most important part of treatment. The diagnosis, prognosis and before care and after care is often as important in a successful outcome. In most surgical tourism from what I can see the before and after care is non existent. So keep in mind that after the Op one still has to present somewhere in Oz to a specialist to get after care.
Overseas “operators” (small word play) do not care about unplanned admissions or iatragentic complications or even long term outcomes and they have no way of responding to them even if they did care. Your hip replacement fucks up and you can’t walk ‘cos you are in pain and the wound is weeping, you are running a temp and your wallet is empty from the Thailand Op. What ya gunna do? Self diagnose? then book a flight back to Thailand next week, then fly 9 hours? then pay again for care? not bloody likely.
Increasingly people are self insuring – so that if its a lowish cost matter like a cataract then they will fork out the $1,500 extra and go private and avoid long waiting lists.
Private hospitals, except where they an cream off low risk – high return patients and procedures are less efficient and more costly than public hospitals. Don’t believe me? If they were more efficient and cheaper then public hospitals and governments would purchase services off private hospitals. Whenever private hospitals have offered to help with waiting lists they have been offered work at the same rates at public hospitals for say the casemix payment (casemix is essentially a unit costing, average or marginal, way of funding hospital care). Private hospitals have never been able to supply the care for the same price as public hospitals.
Lastly; Specialist fees are only a part of the cost of health care. Depending on the area the fixed and overhead costs, excluding specialists, are a significant cost and sometimes the biggest cost driver.
Hi PC. No, I wouldn’t give up your private cover and would use it for dental, elective orthopaedics and the other irritating ailments that need touching up from time to time. The Australian public system is not funded to deal with or particularly interested in aches, pains and minor debility. Although, I always wonder whether a judicious savings account would not do just as well, if not better, than an insurer. That should, of course, not be the case but given one has the public system for the bad stuff it probably is.
My major issue with private medicine is the intrusion on my interactions. I really find an economic element to my consultations quite unpleasant. I would much rather be salaried and just get on with my job. Selfish, but there we go.
Antonio, I would have thought the lower rate of Alzheimers’ was due to the masking from vascular dementia due to multiple strokes.
I think you’ve said it all FXH.
I think thats(sic) being a bit unfair. I recently became quite sick in Canberra (acute, life-threatening) and got bloody marvellous care. It was a the ED at Calvary and in the wards at the same hospital, but I think those bits are “public” and paid for by the Gummint.
Desipis,
“I don’t see any social justice problem with (…) the private system being for those who want to pay more for non-medical benefits (private room etc).”
But why would a top specialist work in the public system full-time? People tend to go private NOT JUST for the non-medical benefits but also because you can have Dr Top-Shit rather than (to use a common stereotype with an uncomfortable resemblance to reality) Dr Just-Starting-Their-Career or Dr I’m-here-because-Australia-can’t-train-enough-practitioners.
“If there aren’t enough doctors or nurses to treat everyone that wants treatment, I’d rather these services be allocated on a medical needs bases rather than on who has the most money to spend.”
This is a false alternative. In many areas the issue isn’t one of “medical need” but one of “ability to provide service”. At the moment, my understanding is that there are no public cardiac surgeons in Rockhampton. This is purely because decent cardiac surgeons could earn a lot more in the private system both here and overseas and the Queensland Health wage and the standard of living in Rockhampton is simply not comparable. What is your alternative Desipis, pay public cardiac surgeons in Rockhampton more? Match the private levels? What will colleagues in Brisbane say? What would stop them equally demanding higher wages? Meanwhile, what is happening to those public hospital waiting lists?
Desipis, I am willing to be persuaded in your health care vision if you can demonstrate to me that talented practitioners will not exit the system for the promise of more money in the private system either here or overseas.
yea, I really don’t know for sure. Was told by a nurse who worked in intensive care though.
But would you happy to be employed at a salary which is equivalent to what you’d be paid if you bulk billed? Because at the moment that is all that the government/community is willing to pay…..
Dr S,
As far as I understand it, the mechanism linking inverse association between nicotine intake and incidence of Alzheimers and Parkinsons is still being investigated. I’m not aware of any currently recruiting human trials
The only data available seems to be epidemiological, animal studies and in vitro biochemical analysis. To date, there have been no double-blind placebo trials: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001749/frame.html
The latest I have read on the mechanism of action is this pretty groundbreaking paper:
Liu Q, Zhang J, Zhu H, Qin C, Chen Q, Zhao B. Dissecting the signaling pathway of nicotine-mediated neuroprotection in a mouse Alzheimer disease model. FASEB J. 2007 Jan;21:61-73.
Apologies for the OT distraction! Back to the discussion.
I live in Broome and for reasons I can’t quite fathom still pay for private health insurance. But it’s total crap, you just can’t find a good private hospital here, I’ve looked everywhere.
I did used to work at one (in Perth) and would agree with Dr S. The nurses did a great job….ringing the specialist to come in and see his post-op patient gone bad…and ringing again etc etc. I can only contrats this with the excellent care I received in the public system when I had a serious health ailment a few years ago which necessitated a stay in a teaching hospital.
Anyway, my main gripe is that Private Health Insurance will pay for a range of alternative therapies (that don’t work) – and the goverment subsidises this nonsense to the tune of 30%. It makes me want to scream.
“Do NOT go to a private hospital if you are really, life threateningly sick. They are very pleasant, the food is nice, everyone is polite but they are not tooled up for it. For instance, you are lucky if there are any doctors on site after hours at all.”
I had a very long and serious operation in the largest private hospital in Sydney’s outer western suburbs for which the post-operative mortality at the time was not insubstantial.
There is no way I would’ve had that op there if I known there would only be one night nurse for around thirty post-operative patients and that the hospital had no resident doctor(s) or a resuscitation team. During a the day a GP visited each patient for a few minutes and that was it until your own specialist arrived.
Yes, the room was nice but that was all.
89 Antonio
I can understand that top doctors will go private for more money, but the way things are, just because they’re private does not mean they are a top doctor either. The money is a carrot for both the good and the bad. There’s no way of judging the doctors credentials either way at present.
In my field (not medical) there are plenty of $hit practitioners who earn a lot of money, and a minority of highly qualified people like me who’ve prioritised other things over the money. I can’t imagine medicine would be so different. Medicine does tend to take the cream of high school graduates – are they all motivated by money over all else? I’m not so sure.
Whatever is happening – it’s pretty hard to find out or quantify.
Mark – I’m not sure about that. We seem to be just as short of nurses as doctors anyway. I suspect it would be better just to fund more university places to train extra doctors – and open up specialist training a bit more. Its not like we’re short of people capable of and wanting to become doctors.
Onimod wrote: “Personally, I’ve paid for private medical care out of my own pocket when required (dental and major surgery) and while I’m not ‘over the hill’ yet it’s been cheaper over the course of my life than paying anything to a fund.”
That’s fine if things go to plan, but you’re scuppered if they don’t. In my case the well-intentioned urologist told me I needed a laser lithotripsy to blast my stone, and could have it done ‘the next day’. What I and (presumably he) didn’t realise was that my stone was a lot bigger and nastier than one procedure could manage (and this was after previous surgeons had had a go at basketing the stone out overseas with no luck).
So, I awoke having had the procedure but still with my goddamn stone and stent (which was causing me all the grief) and now with a $4000 bill. I could have then added on another $4000 for another private go at the lithotripsy but what guarantee that would succeed and I wouldn’t have to have *another* go again either? You can see how quickly the zeros start adding on. Paying by yourself is madness.
Now, although you may have out of pocket costs if you are insured privately, you have to be a smart consumer, and know whether you are covered for X, Y, Z,/ have gaps you have to cover yourself etc.
Plus, if you’re in a family and you get a run of bad luck between the various members, paying out of your own cash becomes unthinkable unless your James Packer. One bad year could wipe out all the savings you have and more. So it’s not really a sensible alternative, IMHO.
I wasn’t an overseas medical tourist, I was just in Ireland when my kidney stone decided to up the ante, Christmas day and everything. What I should have done was stayed in Ireland, bugger the PhD, ‘coz it would have been covered by my travel insurance. Muggins here thought that Australian healthcare system would be better than being away in foreign climes. I have learned *much* from my experience.
“Hi PC. No, I wouldn’t give up your private cover and would use it for dental, elective orthopaedics and the other irritating ailments that need touching up from time to time.”
I just had to get new glasses both reading and distance. I chose the cheapest frames (actually women’s ones because the men’s were dearer). The total cost was $600 for which the fund paid $260. At least it was something.
The local dentist charges around $300 for a filling so it’s now wonder that many people now cannot see a dentist. Without my fund, neither would I be able to.
I’ve been a fund member for over 40 years continuously and on the top table thankfully. After a mental breakdown which led to depressive episodes and a few psychiatric hospitalisations which cost a total of $75,000-00 fully paid for by the fund with no gap. So I don’t think I’m out of pocket just on that one item.
Fair point, although what I guess I meant by non-medical is anything above and beyond the base line ’standard care’. If their particular surgeon wants to charge more then I have no problem with with individuals (or their insurance company) paying more for that. I was making the distinction that medicine should be a public services (like fire, police, roads etc) not a welfare system (only for poor, etc).
Well paying more is obviously a short term solution, but I think it makes more sense to do that then just let people die of heart problems because they’re ‘poor’. Of course if it’s cheaper (and medically viable) to ship patients to a major centre then that should be the route taken. Obviously there’s some balance to be struck on population size and resources expended but I don’t think counting $’s is the way to do it (mainly because with medicine cost, price and economic benefit are so disconnected from each other).
For the long run though, I’d say pay whatever the market demands to get someone to train people. For anyone who undergoes the training, enforce a contractual obligation to serve out a certain amount of time performing within the areas that are in need of such services. I’m sure there’d be plenty of aspiring doctors who would accept such conditions in return for training. They may not be the best and brightest, but they’d be better than nothing (and certainly comparable to overseas imports). The core problem with the ‘market’ in medical services is that those with the skills make more money by artificially restricting supply, thus they have a disincentive to address the supply problems. The long term solution is to get the government to step in a solve the ’skill shortage’ issue, because the market is not going to.
yasmin – I’m lucky – my kidney stones are generally small(ish) and nothing that a good belt of Hillbilly Heroin (oxycontine) or codeine or peth won’t smooth a bit. My last litho blast was years ago and a big stuff up. I’m told the technology is much better now.
Chris – Actually, yes. I have a bulk-billing clinic at a public hospital that works out fine. Mainly because the overheads are lower. ALOT lower. The problem in private is that the it is all preposterously inefficient.
Antonio – I am not sure where you are so this may not be applicable. In the capitals the exact opposite of your reasoning holds, favouring public over private. The first problem in identifying a really good doctor is being in a position to tell one from a personable but slightly hokey one. This gets back to my initial point about the impenetrable information problem, the uninformed consumer.
The second problem is the assumption that a wellspring of money guides medical employment decisions, because it often doesn’t. By the time one hits consultant level, the worst one can do financially is a retirement to University life and a Senior Lecturer salary. Full time public hospital positions pay reasonably well, even if significantly less than private.
The advantage of this is one can do things you actually find fun. Public hospitals pay less but they are often significantly better equipped. Particularly the major teaching hospitals offer a chance to do, study and attempt thing unthinkable in the unadventurous routine of private medicine. There is also the possibility for an academic post which is rather sought after in medical circles, oddly enough considering the prestige accorded to one by other professions.
Bottom line, you want to transplant livers, do coronary grafting without bypass, treat major trauma, work in a major dialysis unit or get involved with epilepsy surgery, get thee to a public hospital and compete like hell for a position.
Now, the first bloke you see will be Mr Registrar but they are backed up by a consulting staff of a significant quality.
The problem comes in far flung places with minimal academic lure and poor pay, such as Rockhampton. Mostly, even there most end up partly in public still, mainly for the greater resources to deal with the really sick but also due to a residual public service commitment.
As to paying a premium for rural sevice, most of us are in support I think. It happens anyway through various hospital agreements in many places. The big problem in Rockhampton was that the various guys didn’t get on and ended up taking their respective bats and balls home. Cardiac surgeons are, it must be said, often highly strung.
Rodney wrote:
“I just had to get new glasses both reading and distance. I chose the cheapest frames (actually women’s ones because the men’s were dearer). The total cost was $600 for which the fund paid $260. At least it was something.”
You can get them online these days, mucho cheapo.
FXH:
My bugger wasn’t moving for love nor money. Pethadine was a blast though. I’m definitely ordering that next time I have a baby. Not sure what the fuss about morphine is, just made me throw up and feel dizzy.
Peh. The “Doctor’s Reform Society”? Well, they [i]would[/i] say that, wouldn’t they?
Dr S – Rockhampton is only about 80,000 people. I’m not sure about Cardiac volumes, research, staff expertise etc but I think I’d be looking to a larger place for my heart surgery.
Sadly, perhaps, these days with technology, rapid advances and changing techniques many procedures and surgery can only really be done in larger population centres. Its been my hobby horse for a while that it is unrealistic populist expectations of supplying sophisticated services in small population centres that drives the employment of Patels and Reeves. They would not have got to the interview committee stage in a large teaching public hospital.
Dr S – So why do you keep on doing private work (not trying to be judgemental here, just curious)? What is that stops you from doing the public bulk billing work full time?
Or did I misunderstand your earlier comment about having to charge extra?
UmmYasmin, that link is awesome.
The last time I went to my optometrist some years ago, before I’d heard of such a thing as a debit card, I carried an envelope full of fifties in my jacket to pay for my new prescription sunnies. I think the other patients thought I was doing some kind of drug deal with the receptionist.
Thanks Dr S, this is indeed one reason I have it — bad luck that, as others have said, teeth and glasses are the main expenses but the most inadequately refunded. (Physio is good, though.)
Is that because so many smokers die before they reach the age when Alzheimer’s kicks in?
Mark, if my own experience of kicking the nico is anything to go by, you will put on 15 kilos overnight and will have recurrent throat infections for about a year, possibly because there’s no vicious toxins in there any more to kill all the germs. The good news is that you will have quite an alarmingly higher amount of money. Also, your singing voice will be better, and your friends will stop glaring at you and rolling their eyes and sighing. But as for the stress of quitting, my sister says go with hypnotherapy. No cravings, no stress, no nothing.
I changed from Medibank Private last year in a fit of pique because I was annoyed that it was going to be sold, and what a five-act opera the process of switching funds turned out to be. Does anyone know what the story is now with Medibank Private? Was it all a total waste of time?
Thanks, Dr Cat, I’ll look into the hypnotherapy angle.
Last time I gave up smoking successfully (for nine months), I managed to avoid weight gain by exercising for about an hour a day and really overhauling my diet. But you’re right about the throat thing!
rodney – you’ll be chuffed to know that Ms FX got two (2) pair of prescription and very fashionable glasses in Taiwan last month for about ~aus$80 the two. Frames, glass and spiffy cases in less than 24 hour turnaround.
Spectacles in Oz are priced by the oligopolists to about a 1,000%+ mark up. Essentially all frames (90%)are made in China from pretty ordinary materials – yes even the designer Made In Italy ones. Not much to most of them either – just plastic.
Chris – I, like so many other commenting here rather than working, have a PhD to write and a short time to keep the child fed and mortgage paid. Hence, what one can get. Victorian public hospitals are getting out of the outpatients game. This means sessional work can be tricky to come by except on a private basis.
LOL @ Liam.
The trick is to go to an OPSM, Merringtons, Whathavyou and pick out the frames you like. See an in-house optometrist. Ask for the actual prescription (they may grumble at this, but it’s yours not theirs) and then go shopping online.
It’s the only good piece of advice I’ve got out of my occasional flick-past Today Tonight (or was it A Current Affair, who knows, who cares).
BTW Mark, my husband used hypnotherapy and nicorrettes to give up smoking and it worked for him (alongside threat of divorce from me if he kept smoking errr..).
Heh! Actually, Yasmin, my 9 months giving up episode started off when my then partner said – “you have to choose between sex and smoking”. She was serious!
FXH – Rockhampton is small but the catchment is large. I don’t think volume was a problem. The lack of university involvement can be an issue but places in FNQ at least have gorgeous climate on their side. Imagine recruiting for Ballarat…
Either way, I don’t think the quality of the work was at issue, there was a massive barny between the surgeons. Just going on the reporting here, never been up that far myself.
Dr S – regarding FNQ- I am unable to trust anyone in shorts.
Rocky’s in Central Queensland!
Mark – I even have trouble with people in Mildura. Or Bendigo.
Actually, FXH, my uncle lives close to Rocky, and has had major problems seeing a cardiologist. But Brian is across the details, and I’m not.
Mark: See, now that’s just punishing herself
Strangely, Yasmin, that argument didn’t fly!
97 Umm Yasmin
yes – if a lot goes wrong you can be well out of pocket, but who do you think is paying for your experience? It’s everyone else who doesn’t have those problems in their lifetime. Insurance doesn’t just invent money – it only shares it around.
Also – I’d hardly consider a six month diagnosis period followed by an 8hr surgery (planned to be 3hrs max) as things ‘going to plan’.
I’d be happy to consider paying if I knew paying covered all of my potential cost risk, but it doesn’t, and over a period of time it’s been cheaper to “self-insure”.
My other point was the discrepancies in charge rates – if you chop those numbers of yours in half (fund vs cash/cheque to ethical doctor – for some services I paid less than half), average them over your lifetime and then compare them to your private fund outgoing. What’s the comparison then?
PC @ 26
Like Dr S said (#58), that surgeon is telling big, fat and very self-serving porkies.
I have worked in both public and private systems, and I hate the private insurance system, it is an utter scam (though I am not opposed to private practice, which is a different thing).
FXH @ 85. Well said.
Dr S @ 86
My major issue with private medicine is the intrusion on my interactions. I really find an economic element to my consultations quite unpleasant. I would much rather be salaried and just get on with my job. Selfish, but there we go.
Not at all selfish. I have heard precisely those kind of comments from countless medicos.
Dr S. @ 102
The problem in private is that it is all preposterously inefficient.
That is my experience.
Well with all insurance if you average it over long enough you’re going to do better by self-insuring (its the nature of insurance). On average people lose money with their house insurance and their car insurance. Its whether or not you can handle the spike in cash required when things go bad – and resist the temptation to spend the saved money on holidays, toys or even the mortgage when interest rates go up etc. Otherwise you find yourself with both no insurance and no piggy bank to draw on.
OT: Hypnotherapy for smoking cessation doesn’t look that great.
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001008/frame.html
Which actually brings me to a supplementary point. So much money is expended on therapies with little or no dubious health benefit as assessed by controlled clinical research. Significant savings for both the government and individuals could be made if both the practice of medical research and the published results of said research were put into the practice of medicine.
Too many practitioners ignore emerging clinical research evidence in favour of outmoded and often ineffective treatments. For example, elevated lipids could be treated with a mediterranean diet, fish oil and pro-active margarine before PBS-subsidised statins are prescribed. All simple non-interventionist therapies with a raft of clinical evidence verifying effectiveness.
And don’t get me started about proposals to government fund “natural medicine” untested in a doubleblind placebo setting….
On a gratuitous note of personal abuse: can someone remind me who that hideous spokesperson for private health was a few years back?
You know the one, a dodgy Arthur Daley type, the sort of pond-scum that the Howard era seemed to flush to the surface.
I see the industry had the good sense to get rid of him. I imagine he ended up in HIH, or possibly working for Australian wheat’s export wing.
For example, elevated lipids could be treated with a mediterranean diet, fish oil and pro-active margarine before PBS-subsidised statins are prescribed.
Actually the evidence for Fish Oil is not all that compelling and the brands available here do not reflect the proportion of omega 3 fatty acids used in the clinical trials, the pro-active margerine does not have a welter of clinical outcome data either (rather than proxy measures). Still, Fish oil and the med diet aren’t likely to cause you any harm either.
As I mentioned earlier, the government is already funding unproven therapies, albeit indirectly through the 30% heathcare rebate.
A friend once pointed out to me that any money you lose gambling isn’t “wasted” — it’s just the price you were willing to pay for the fun/entertainment/self-indulgence of gambling. Even as a non-gambler I think this is a very good argument, and a version of it can be applied to any form of insurance: think of it as money you pay to free you up from fretting.
OT again (though not entirely) — Antonio, that hypnotherapy link is very uninformative. All it really says is that they don’t know. But most of the psychologists whose views I’m familiar with use hypnotherapy regularly in the treatment of various addictions and other behavioural problems, and some hospitals do as well, for things like pain management. The stats would be skewed by the fact that not everyone is a good hypnotic subject, and if one isn’t then it won’t work for one. Some people’s personalities are more defended than others’.
Don’t knock it till you’ve tried it, I say.
I use cholesterol as an excuse to start a lipid-lowering drug. There is no doubt that high cholesterol is a cardiac risk factor and that diet lowers it. There is doubt about how much that helps your risk of dropping dead. Statins, on the other hand, drop your cardiovascular risk by a third or so. No matter what your cholesterol is. No matter if there is no change in your measured cholesterol. It appears to be a secondary action that does the deed rather than the cholesterol lowering effect.
You want to reduce overall health costs, this is one of the drugs you remove restrictions from.
rf,
I have no idea what you are talking about and with respect, I’m not sure you do either! I was a co-author on the forthcoming National Heart Foundation Position Statement on Fish Oils. Fish Oils were pretty much my work life for 3 years!
The amount of EPA and DHA (the “good” fish oils) in fish oil capsules vary according to the brand and the product but the exact concentration is always mentioned on the label. So as we advise in our position statement, 2g of EPA+DHA per day is advisable. Whether that means 10 capsules of the low strength cheap fish oil capsules or 3 capsules of the super strength MaxEpa etc is fine.
The GISSI-P trial, the DART trial and the JELIS trial are the big studies demonstrating cardiovascular benefit with marine omega-3 Fatty Acid intake. Given the large numbers in these trials, the additional evidence in around 2 dozen smaller studies, the epidemiological and in vitro evidence, this really is settled science!
There is a stack of clinical evidence relating to plant sterols (the active ingredient in pro-active margarines) from clinical trials and in vitro. The CSIRO is engaged in a major research project on the topic: http://www.csiro.au/science/ps8n.html
For a detailed discussion of the evidence relating to plant sterols see the “Summary of evidence on phytosterol/stanol enriched foods” on the National Heart Foundation of Australia’s website – http://www.heartfoundation.org.au
Again, the clinical evidence is largely settled with majority of research now looking into mechanisms.
The health benefits of the Mediterranean Diet were first established by Ancel Keys in the 7 Countries Study and later verified by the Lyon Diet trial. The inverse association between a Med Diet and Heart Disease has been well established now for some time with a raft of “me-too” clinical studies. There is emerging research on the effect of the Med Diet on non-cardiac conditions like depression, DM-2, metabolic syndrome, rheumatoid & osteo-arthritis etc.
rf, misinformation such as that which you have written above is just the kind of premise that many people use to by-pass diet & lifestyle therapy straight onto taxpayer funded drug therapy. All of which only sucks up more public funding that could be better used on training health professionals, educational campaigns etc.
Pavolv’s Cat,
The Cochrane Collaboration is the Gold-Standard in effective health therapy assessment. They only include research which is double-blind placebo-controlled.
Have a look at the full paper which looks at 14 different methods and includes nine published studies which meet the minimum criteria for a double-blind placebo-controlled trial. The review is a detailed review which meta-analyses the data and adjusts for heterogeneity. Quite simply if there is no evidence that a given therapy is better than placebo or no-therapy at all – ie. in other words if there is no clinically significant difference then that’s pretty good evidence that it doesn’t work!
Dr S,
I completely agree. I am referring to GPs that put patients with an LDL of around 3-4 on statins. Obviously LDL should be as low as possible (lower than 2 would be good, cf. ATP-III guidelines) and HDL should be as high as possible. However where there is only mild dyslipidemia (LDL 2.5-4), then dietary modification really should be considered first. If the LDL is way out of control (ie. ~4+) and the HDL isn’t high enough to be protective then obviously statins/fibrates/niacin should be considered.
Whatever you say, Antonio.
“Don’t knock it till you’ve tried it, I say.”
I prefer Richard Dawkins comment: “It’s good to have an open mind but not one so open that your brain falls out”.
Still, booga booga treatments like homeopathy, naturopathy, psychoanalysis etc.. do appear to produce a decent placebo effect and that makes them valuable in their own way. I wonder if the placebo effect is enhanced in direct proportion to gullibility?
Antonio, did you look at Portulaca oleracea? If so, what were your findings?
The Cochrane Collaboration is the Gold-Standard in effective health therapy assessment. They only include research which is double-blind placebo-controlled. Antonio @130
Not strictly true. Non-pharmacological psych studies are generally not (and, indeed, cannot be) properly placebo controlled, nor hence double-blinded. It is a serious problem and limitation in this area of medical research.
Furthermore, neither the degree, form, nor even the existence of the placebo effect itself, is certain any longer. Some solid meta-analysis by Hrobjartsson and Gotzsche has raised very serious questions about the placebo effect. I no longer take it for granted.
I wonder if the placebo effect is enhanced in direct proportion to gullibility? Mel @132
The polite way of saying it in formal studies is ‘patient expectation’.
Well, I tried hypnotherapy with a psychiatrist to assist with me insomnia. And it really did help enormously, so I recommend anyone to at least try it. Apparently, I was an excellent subject, which kind of appalled me. But the good doctor, who looked just like Freud flattered me that it just showed how open and creative I was.
Onimod wrote (@121):
yes – if a lot goes wrong you can be well out of pocket, but who do you think is paying for your experience?
Let me present the problem this way: I am employed and a contributing taxpayer, with a family to support. I am also young and it is early in my career so I don’t have lots of savings and I haven’t paid heaps of tax yet. However, I plan to stick around in Australia, working and contributing and bringing up my family to be working, contributing citizens. Unfortunately, I am unlucky enough to develop this awful kidney-stone.
Sure, in the short-term my fellow taxpayers (and in the case of insurance, fellow insurance members) are putting up dosh for me to have my procedures, but if I have my procedures and go back to work, I will be able to keep contributing to society.
On the other hand, as Different Chris pointed out, if my family cannot absorb that spike, I either become ill and infirm and cannot look after my daughter because of my illness, thus depending on welfare for my chronic illness, or I have the procedures, go bankrupt because we use up our savings, and then become dependent on welfare.
I’m not sponging off other taxpayers, I am quite happy to contribute my taxes for the welfare of me and my fellow Australians who might also need medical care. And call me a humanitarian, even if my friend’s 1.5 year old son develops leukaemia (which actually happened) and needs all sorts of treatment (including chemo and a bone-marrow transplant) the amount of which their Medicare levy will never fully pay-off, I still feel good about contributing my taxes to his care, because that’s the type of society I believe we should have.
Mel, I too am sceptical about homeopathy and naturopathy (two things that are quite different from each other, as you don’t seem to be aware) but it would never occur to me to be so pig-rude as to accuse the people who do set some store by them of having had their brains fall out. But if you think hypnotherapy is a ‘booga booga treatment’ then I suggest you ask some actual psychologists what they think.
Unless you think psychology is ‘booga booga’ as well, of course.
[Granted, this is a bit OT!]
Hilker,
I haven’t yet seen a human trial specifically looking at Purslane consumption. However, I remember reading that it is high in ALA (a non-marine omega-3 fatty acid), to which we say in our position statement:
“In summary, the ALA supplement trials were unfortunately inadequately powered to assess benefit and in the case of the Norwegian trial follow up was far too short and there were too many drop outs. It is not clear whether ALA does prevent recurrent coronary events although there are trends to suggest that this may be the case.”
We will have to disagree about the placebo effect Hilker!
Although, I do think that the methodology of the review was pretty rigorous regardless (and serves as an admirable example of how best to assess therapeutic claims for the purpose of public policy!):
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001008/frame.html:
“Methods of the review
We checked all of the trials identified against the inclusion criteria. The three authors independently assessed the quality of the trials meeting the criteria, using a standard scoring sheet. We settled any discrepancies by discussion. For each included trial, we extracted information on smoking cessation rates after six months or more, the method of randomization, and whether an intention-to-treat analysis could possibly be done. If the results were not based on an intention-to-treat analysis but drop-outs were recorded, we recalculated the results to include all randomized subjects, with those lost to follow up assumed to be continuing smokers. We used the strictest criteria for abstinence. Where appropriate, we calculated a pooled odds ratio using the Mantel-Haenszel method. We tested for statistical heterogeneity, and where we found it we made judgements as to its source in the patient population, interventions or outcome assessments.
(…)
Methodological quality
We assessed the quality of study design was based on a) randomization, b) verification of smoking cessation and c) blinding.
a) All of the included studies mentioned randomization but none stated the method in enough detail to assess whether randomization achieved adequate allocation concealment.
b) Studies used a variety of methods to assess smoking cessation at six months or later follow up: two studies measured serum thiocyanate during the study programme but in both cases abstinence at six months was based on self report. The other studies used self report obtained by a personal or telephone interview or by postal questionnaire, or did not state the method of follow up.
c) No studies stated that the outcome assessor was blind to the treatment group of the participants.”
“But if you think hypnotherapy is a ‘booga booga treatment’ then I suggest you ask some actual psychologists what they think.”
I never said hypnotherapy is booga booga. Not sure where you got that idea.
I think Dawkins’ comment was partly in jest. Settle down.
This medical site indicates there is some scientific support for the efficacy of hypnotherapy. http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-5fe33da65dd4&chunkiid=37407
I’m not surprised.
135 Yasmin
I’m sorry if it seemed so, but I certainly wasn’t suggesting that you were sponging.
Definitely not.
I’m not suggesting that self insurance is the only answer either – but it is another possibility.
My experience was a major health crisis that halted a career in professional sport at the age of 21. I had no choice but to pay up front as time was critical and as a struggling sportsman/part time worker and student I too had no choice.
There was a cost spike, no doubt, but with the right doctors who knew my financial predicament I was able to secure top private medical care at a much lower rate than i could have if I’d presented as an insured patient, and I know a few people who have done the same.
That’s my main point – medicine can be a lot cheaper than it is a present. Insurance funds aren’t making it cheaper, and they’re distorting peoples choices and outcomes because unless you’d been through the process, you’d never know any better.
I’m not trying to put your choices down and I’m sorry if it seemed that way – I’m just presenting an alternative illustration that fits along side, not in opposition to, your choices. I’m not suggesting that you’re sponging. If anywhere the sponging is in the executive of the health funds who have minimal contact with either you or your doctor. Remoteness is the easiest way to turn a social decision in to an economic one.
If Nicola Roxon’s proposals are opposed by the AMA here must be some merit in them.
“Hi PC. No, I wouldn’t give up your private cover and would use it for dental, elective orthopaedics and the other irritating ailments that need touching up from time to time.” Dr s
I just had to get new glasses both reading and distance. I chose the cheapest frames (actually women’s ones because the men’s were dearer). The total cost was $600 for which the fund paid $260. At least it was something.
The local dentist charges around $300 for a filling so it’s now wonder that many people now cannot see a dentist. Without my fund, neither would I be able to.
Whilst backpacking last year, near Loas border, offspring one broke front tooth off. Had tooth reconstructed in a Bangkok Dental hospital that looked more like the Sheridan , complete with uniformed doorman. Had the work critiqued back here in Oz – they said it was a top job. All for $50. No prizes for where i’m heading for a bunch of veneers, a crown and bridgework.
On the other hand, if my kidney or liver failed, i don’t think in many better hands than the PA in Brisbane, where i’m currently working.
[BTW Perhaps the ethics of organ transplants/donor $ incentives could make a great thread one day
http://www.youtube.com/watch?v=Ur7WRvh_un4]Seconded. For the exact same reason. Props, my hypno brother (or sister, sorry, can’t remember)!
Took a bit of ‘practice’ but did really help, and i was very skeptical, and also no the world’s greatest subject I’m told.
(btw one day i’m gonna re-read my posts and spell check ‘n edit before i hit send
)
If you want to talk booga booga i should mention the inclusion of subsidies for aromatherapy by Private Health insurers was NOT a selling point and a red flag that Private health insurance is more about marketing than health.
http://209.85.173.104/search?q=cache:18NF_RhYMAQJ:www.atms.com.au/PDFS/Health%2520Fund%2520Table%2520for%2520Aromatherapy%25202006.pdf+health+insurance+aromatherapy&hl=en&ct=clnk&cd=1&gl=au&client=firefox-aWhy should I waste my money with private health insurance when they offer cover for non-medical crud like naturopathy, homeopathy and reflexology.
Rhondz, uh, cause they offer coverage for things like dental, physio etc.?
That seems like a pretty silly statement.
RhondZ You don’t have to get cover for that ‘crud’. I believe that you can choose the sort of cover you get and only get hospital or ambo cover and not choose ‘extras’ cover, if you feel that only ‘crud’ is offered.
The system is mixed private/public and thats the approach we take in my family. We went public for the kids births and the one broken limb, and private for dental, chiro, optical, and the elective surgery my husband had. I would ideally like to self fund, but I know that we would probably spend it faster than it would build up. The reason my husband convinced me to get private cover was the horror stories of his work mates and the differing experiences of people with kidney stones (Private cover = quick removal, versus no cover = waiting list). We are with a not for profit insurance company and receive fairly generous benefits. I think that the non profit versus profit type of company you are with can make a huge difference. My parents in law are jack of their insurance company (one of the biggies) after getting 2-3 thousand $ worth of dentristry done and only getting $200 back.
antonio – Cochrane – uses best evidence available and mostly meta studies – - sometimes there is no double blind available.
Onimod wrote @140:
“I’m not trying to put your choices down and I’m sorry if it seemed that way”
Woops, should have put a few emoticons in my last reply, I wasn’t upset just finding the thread stimulating.
“My experience was a major health crisis that halted a career in professional sport at the age of 21. I had no choice but to pay up front as time was critical and as a struggling sportsman/part time worker and student I too had no choice.”
Yikes, I’m sorry to hear that, it must have been pretty devastating.
I certainly take your point about fees being somewhat arbitrary. Having said that, it is because we are largely sheltered from the cost, is what makes me so thankful to be in Australia as compared to the United States. (My medical woes not withstanding).
I’d pay privately and upfront if there was some ‘insurance’ against the risk of the procedure not working. I think that is what hit me so hard. I went to sleep with a kidney stone and a stent, and I woke up with a kidney stone and a stent and a $4000 bill.
I went to sleep with a kidney stone and a stent, and I woke up with a kidney stone and a stent and a $4000 bill.
If the surgeon was in the building trades he’d have to do it again, in that case, and wear the cost himself. Is there no such provision in medicine?
Antonio at 129, the Cochrane meta-analysis published in 2004 concluded “it is not clear whether dietary or supplemental omega 3 fatty acids alter total deaths, cardiovascular mortality or cancer risk in the general population or in people at risk of or with cardiovascular disease”
The number needed to treat from the GISSI prevenzione study was 77 – i.e. 77 people neede to take omega -3 supplements for 3 and a half years to prevent one extra death, non-fatal MI or stroke. It would also help if you are post MI as were the trial particpants. The JELIS study is singularly unimpressive too, and unless you are Japanese and already consume a diet high in fish and have a high cholesterol and are prepared to take the single n3-PUFA used in the trial for 5 years, I’d say forget it. A NNT of 142? And you’re convinced that the evidence is settled? What about the DART 2 trial which had negative results?
I’d like to believe that fish oils are demonstrably good for you and I certainly wouldn’t dissuade anyone from eating fish but I (and others) am not convinced that fish oil supplementation is worthwhile.
Your enthusiam reminds me of Dr Peter Clifton, interviewed on RNs health report by Norman Swan “so I think fish oil does have benefit but the trials do not have not been sufficiently well designed or well funded enough to clearly demonbstrate this”.
So…..don’t accuse me of misinformation.
[More OT, I admit!]
rf,
There were serious concerns raised about the statistical methodology used in that Hooper et al’s Cochrane review (raised in BMJ etc) and my current understanding is that that Review will be redone. The second co-author of the Cochrane Review was a co-author of the DART-2 paper which was not disclosed in the review. Furthmore, the DART-2 study has been seriously attacked for failing to control for non-compliance and statistical heterogeneity between the cohorts that consumed fish and those that consumed fish oil. In fact, the trial was stopped halfway through and restarted some years later due to lack of funding. This severely impacted on follow up and the rigour of data.
In the full position statement, below is the extract relating to both that Cochrane Review and the DART-2 trial:
“Under the auspices of “The Cochrane Collaboration”, Hooper et al reviewed 48 randomised controlled trials (36,913 participants) and 41 cohort studies, published up to February 2002 . This meta-analysis was widely reported as showing little clinical benefit of marine n-3 FA intake. The only significant major trial added to the aforementioned meta-analyses was the Diet and Reinfarction Trial-2 (DART-2) which was published after the February 2002 cutoff. The inclusion of the DART-2 trial led to significant heterogeneity between the trials. It is extraordinary that the DART-2 trial was included in the meta-analysis as it did not fulfill the inclusion criteria for this meta-analysis. Additionally, as noted below, this trial appears to have been conducted in a somewhat problematic fashion. The explanation for inclusion of this outlier trial in the Cochrane Collaboration may be that Ness was an author of both the DART-2 trial and this Cochrane Collaboration meta-analysis.
Heterogeneity refers to variation in observed treatment effects. It is generally accepted that when data is significantly heterogeneous it is unwise to proceed to the statistical aggregation of meta-analyses . When heterogeneity is significant, cumulative meta-analyses or sub-group analysis may be valid and valuable. If these guidelines are not followed, there is a high risk of incorrect conclusions being drawn from the pooled statistical analysis.
While acknowledging the heterogeneity with inclusion of DART-2, Hooper et al nevertheless reported their formal meta-analysis. It has not been widely appreciated that this Cochrane analysis revealed that even when DART-2 is included, there is a significant decrease in total mortality with a relative risk of 0.90 (95% CI 0.83-0.98, P=0.002) with high marine n-3 FA intake. When the DART-2 trial is removed, the pooled analysis revealed a higher benefit with high marine n-3 FA intake with an overall relative risk of death of 0.83 (95% CI 0.75-0.91) and now with no significant heterogeneity (a more robust analysis).
The major source of heterogeneity between the cardiovascular outcomes of DART-2 and those of other trials is the apparent increase in sudden death (but lower overall CHD deaths) with fish and fish oil intake in the DART-2 trial. In the actual Cochrane meta-analysis tables, data from the two-way analysis rather than the four-way analysis was used both for DART-2 and from the Gruppo Italiano por lo Studio della Streptochinasi nell’Infarto Miocardico-Prevenzione (GISSI-P) trial. The numbers used for the DART-2 trial are correct but unfortunately the numbers were misquoted from the GISSI-P trial. On the two-way analysis, there were 122 sudden deaths in 5666 individuals on the high marine n-3 FA in comparison to 164 out of 5668 on the low marine n-3 FA. However, in Figure 11, Hooper et al incorrectly quoted 111 (out of 5665) versus 154 (out of 5658) sudden deaths in high versus low marine n-3 FA intake respectively. In an online communication Pascal Huvé drew attention to another possibly relevant error in this meta-analysis. In Figure Two of the paper, “Effect of omega-3 fatty acids on mortality”, in the subcategory “RCT data, a linolenic acid only”, the total number of events for low omega-3/control should be 68, rather than 58. This correction would appear to imply a non-clinically significant difference between the low omega-3/control group (n=68) and the high omega-3 group (n=72).
The actual DART-2 trial execution undermined the results of this trial. In the trial, 3114 men with angina were randomly allocated to four separate diet groups and followed for three to nine years. Due to lack of funding, the trial stopped recruiting patients for twelve months during the recruitment phase. Members of the first group (n = 764) were instructed to “eat at least 2 portions of fish each week or up to 3gm of MaxEpa fish oil (marine n-3 FA supplement capsules 18% EPA, 12% DHA) as a partial or total substitute.” Members of the second group were advised to eat fruit and vegetables, members of the third group (n = 807) were advised to adhere to a diet combining both of the recommendations of the first and second group. The fourth group advised “sensible eating” which did not include any of the aforementioned dietary options. In Phase One of the trial, fish oil capsules were initially only given to men of the first and third group who found eating fish unpalatable. It is unknown how many members of the first and third group in Phase One took fish oil and for how long, and whether or not compliance was measured by pill count. Only 39 members of the first and third group in Phase One had plasma EPA measured at baseline and six months in order to assess compliance. In Phase Two of the trial, some members of the first and third group were sub-randomised to receive either fish advice (n = 1109) or capsules (n = 462). It is not known whether participants who chose to take marine n-3 FA supplements in Phase One were included in this sub-group in Phase Two.
In the 462 men allocated to the “fish oil sub-group”, marine n-3 FA had no effect on total mortality. There were a total of 59 CHD deaths (HR 1.45: CI 1.05-1.99; P=0.024) and 24 sudden deaths (SD) (HR 1.84: CI 1.11-3.05; P=0.018) which were increased compared to the “no diet advice” group in which there were 67 CHD deaths and 17 sudden deaths. The total mortality in both groups was 83 versus 84 respectively. Classifying deaths as SD or not is best avoided unless there is careful adjudication and consistent criteria for definition and adequate numbers for mathematical analysis. The most robust number is the total CHD deaths – which are virtually identical and are consistent with similar treatments and diets in a contemporaneous “research unsupervised” population of patients with angina. It is also important to note that within the DART-2 trial in the “fish oil group” and the absolute numbers of CHD mortality and sudden death are small and confidence limits are large. The issue of compliance is a major concern with the DART-2 trial as face-to-face contact only occurred at baseline and six months in Phase One.
Seventeen months after the publication online in the Cochrane database, this meta-analysis was republished and widely publicised as yet another new study showing lack of benefit of marine n-3 FA supplementation. This “new” study again only included electronic based searchers to February 2002 (though again it did include DART-2 published in 2003). No new trials were added to the original review. This review ignored the four important large cohort studies as mentioned above as well as the large JELIS trial (see below) which confirmed the GISSI-P trial findings (see below). Such omissions are hard to explain. A recent comment in the Lancet stated that “…to ignore the emergence of new information might therefore undermine the validity of systematic reviews .” Inexplicably Hooper et al continued to include data from a discredited researcher (Singh’s fraudulent “Indo-Mediterranean Diet”) about patients who may not have existed. The British Medical Journal and the Lancet in July 2005 have clearly documented the fraudulent research.
A number of letters to the editor regarding this paper were published online. Siscovick and Willett politely noted that the exclusion of numerous observational studies evaluating fish intake is puzzling and markedly limits their cohort meta-analysis and further noted that more complete meta-analyses of prospective cohort studies demonstrated clear associations between fish intake and reduced risk of CHD deaths and ischemic stroke. Lund noted that Hooper et al stated that the design of the meta-analysis excluded multifactorial trials, however Hooper et al had actually included a multifactorial trial – the DART 2 study which subsequently caused problems with the meta-analyses.
Lund also noted that the credibility of the review would improve if all the published papers and all trials with multifactorial design had been included in the meta-analysis. Ka He who previously published two comprehensive meta-analysis , found the conclusions of Hooper et al somewhat misleading. He stated that Hooper et al had excluded 108 potential cohorts that had no omega-3 assessments which subsequently decreased the power of the study, yet questionably included the DART 2 trial on the basis of its measurement of EPA levels. Additionally, as mentioned above, only 2% of participants had their EPA levels assessed (68 patients).
Finally, Rice (a co-author of the generic health claim commission of the omega-3 health claim consortium to the Joint Health Claims Initiative in the United Kingdom ) noted that the Cochrane review process in assessing diet and chronic disease has significant problems . This view had earlier been stated by Truswell in a critical review of the Cochrane methodological approach to meta-analysing dietary intervention trials . Rice stated that uncritical usage the DART-2 trial is unscientific and basing a meta-analysis on an uncritical interpretation of selected papers is a gross disservice to the communication of scientific information. Finally, Rice went so far as to urge the authors and the BMJ to correct the situation via a retraction. Hooper et al published a response which somewhat confirms our analysis of the inadequacies of this review as noted above.”
Anyway rf, this is all getting rather off the original topic of this post! However, your short dismissal of evidednce relating to the health claims of a relatively inexpensive and easy to obtain therapy (scil. “Fish oil”) really do demonstrate to me the level of misinformation relating to preventative healthcare information in Australia. The impact of NOT heeding the mass of scientific evidence relating to preventative and/or non-pharmaceutical therapies will be felt in taxpayers pockets in years to come with a rapidly ageing population.
Public expenditure should be put into researching preventative and first-line non-pharmaceutical therapies that could potentially reduce incidence over the medium-long term. A really useful example of this relevant to this discussion on how government-initiated dietary education, counselling and legislation can have a positive impact on health outcomes occurred in Finland – where the results were nothing short of astonishing!
http://www.kantele.com/nwfwebsite/puska_heart.html
http://www.ktl.fi/portal/english/research__people___programs/health_promotion_and_chronic_disease_prevention/projects/training_seminar/north_karelia_project
A good statistical analysis of the project appears here:
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WPG-45N43TF-19&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c965f95105be72bcad70d4050e9b8124
Pietinen P et al. Preventive Medicine. 25(3)1996, pp.243-250
149 Umm Yasmin
Agreed, and with Helen at 150 too.
Could be worse though – the guy in the bed next to me at the time came out of theatre with a new knee, but left the hospital in a casket…
Antonio, you’re right; we shouldn’t derail this thread. However, your enthusiasm for Fish Oil as a mass preventative is not supported by current evidence. I don’t think we need a lengthy analysis of the JELIS or GISSI-P trials to see that the benefits are at best, modest, and in only narrowly defined trial populations. I’m aware of the limitations of the DART-2 data and await further analysis with interest.
My view is that the Numbers needed to treat are not compelling – and will be even lower in real life.
Observational data? Yup, all interesting but again, not compelling. Having said all that (and in an attempt to stay on topic) there is more evidence for fish oil than some of the other complementary therapies that Health Funds are prepared to pay for. But that is not saying much.
a link to a 2005 Parliamentary research note titled:
http://www.aph.gov.au/library/pubs/RN/2004-05/05rn54.pdf
“Public versus private? An overview of the debate on private health insurance and pressure on public hospitals”
the note concludes:
While private hospital activity has certainly increased since the introduction of the government’s private health insurance incentives, so too has overall demand for hospital services.
This trend in overall demand for hospital services partly reflects demographic changes in Australian society, and thus can be expected to continue in both the short and long terms as the Australian population ages. Yet at the same time, some researchers argue that the very existence of private health insurance incentives have the potential to create the perception of increased capacity, which in turn may itself create increased demand. In other words, the perception of increased capacity creates a ‘tendency for people to use more of a service if it is free or low cost at the time of delivery’.28
“The research surveyed for this Note suggests that there is no clear correlation between increased levels of private health insurance membership and the extent of ‘pressure on public hospitals’. What the debate over private health insurance and public hospitals does demonstrate, however, is the complexity of the Australian hospital system itself. For example, the structure of the market for hospital services is such that public and private hospitals tend to deal with different kinds of caseloads.
This helps to explain why the introduction of incentives into the private health insurance market has not led to a neat shift in workload from the public to the private sector. But the supply of both public and private hospital services is also influenced by a range of intricate, interrelated factors, such as workforce, financing and resource arrangements, developments in medical technology, and demand.
Further, much of the debate about private health insurance and pressure on public hospitals hinges on the unresolved issue of whether the public and private hospital systems are designed to complement one another, or whether they are in competition. Subsequently, whereas the available evidence is inconclusive, much of the debate about private health insurance and pressure on public hospitals in Australia is informed by positions taken in this broader ideological debate.
Clearly, both the public and private hospital sectors play an important role in the delivery of hospital care in Australia. The role that the government’s private health insurance incentives play in the distribution of hospital services between the public and private sectors, however, is far from clear cut.”
“Far from clear cut”… in other words…..sorry boss, the evidence doesn’t stack up, no matter what you and the Private Health Insurance mob want to spin for public consumption…it’s complicated AND partisan, and since you won’t be in office in two years time, why don’t you just talk up ministerial control of RU486 and STATE GOVT public hospital waiting lists.
And what Dr S and FXH have posted.
I’d love to hear other people’s spin and advise on this private health insurance versus public …
I am 52 years old and a Mother of 5 grown children. Together with my husband we have always worked both running our own businesses and as employees and have always paid our taxes. Some years ago – for several reasons we consciously decided to allow our private health insurance policy to lapse. However I always continued with private ambulance cover.
Touch wood we have been a lucky family with extremely rare visits to the doctor and thus far never a need for a time spent in hospital for any of us (just for the curious I gave birth at home with midwives).
Suddenly I develop a problem with my knee, painful enough to drive me to the doctor after only a few days of experiencing the pain and swelling – most unusual as I would generally hold off and attempt to treat it myself with some simple home grown and herbal bits and pieces.
However doctor says I need to see a knee surgeon quite quickly – asks if I have private health insurance, to which I say no. He grimaces and says I can make an appointment with the knee surgeon he is referring me to, in his private clinic – he will want an x-ray and possibly and MRI scan and then I can discuss private or public surgery.
No worries – I am prepared for the initial $1,000+ cost to get a specialist diagnosis. After this I’ll make a decision about how necessary an operation is and if so I’ll research paying for the operation or getting in the public health system queue – I am not delusional either way – it’s a hip pocket expense or a drawn out painful physical expense.
I go to make the appointment with the specialist and his receptionist informs me that he will not see me in his private rooms unless I am privately insured. I explain that I am happy to pay his full service fee at the time of the appointment. No I am told I must see him at the public hospital. I explain that my doctor says it is fairly urgent and I cannot afford to wait long for the diagnosis and treatment. Receptionist tells me I should be fine getting a fairly quick appointment at the hospital. The hospital tells me, first available appointment is the end of December – no way of getting on an urgent wait list. I ring back to his rooms and again explain to receptionist that I am more than happy to pay the full amount of a private consult etc. etc. – I am told in an extremely stern manner that the doctor WILL NOT SEE ME IN HIS PRIVATE ROOMS UNLESS I HAVE PRIVATE INSURANCE. I start to get my back up and say that I do not understand what the difference is between insurers money or my cash money – if we are paying the same fees surely there is no difference. I also explain that I find this policy completely discriminatory. The receptionist’s tone becomes increasingly condescending and patronising, she tells me that unlike many other surgeons this doctors gives his time to public patients at the hospital once a week. And if I do not have private health insurance then that is where I will need to line up to see him. I tell receptionist that her tone is utterly rude and that she makes it sound as though this doctor ‘tithes’ his timely generously and freely each week to the poor plebs who are not covered by private insurance. Whereas my understanding of public hospitals is that these doctors are well paid via tax payers money for this time spent seeing public patients.
I also explain to receptionist that there are people such a myself, who opt not to have private health insurance and are willing to pay for a medical procedure including private doctors fees, private hospital, surgery time, anastheatics etc. etc. Receptionist laughs and wishes me well with my crusade and hangs up on me.
I ring my GP back outraged and he mumbles something about it possibly being complicated with this doctors work cover if I am not privately insured!!!!????
Can anyone out there throw some light on this – what’s the spin – I’d love to hear your feedback and advise.
I’m in shock – is this truly the kind of discrimination that our doctors will resort to?
Private health insurance is a business… why does it need a Govt subsidy to survive
via a forced higher medicare levy?
I suggest such changes as put forward by our labor govt are well justified
Two of my children have had surgery in the past three years as “private uninsured” – one as a day patient and the other with one or two nights in hospital (can’t quite recall how long). There was no drama with either. We paid the gap between the Medicare rebate and the fee – one was around $1300 and the other $400. We are still way ahead. We have ambulance cover and “extras” cover for dentistry etc.
I’d ask for another referral – and complain to the registration board. Even if they can’t/don’t do anything they should be told about this type of discrimination.
Thanks Eds Mum – this is what I had thought. And this is also the calculation my husband and I did some 18 years ago with allowing our private medical insurance to lapse.
We weighed up the odds – looked at years of track records with how infrequently we used doctors – looked at medical history of family etc and thought let’s do what we believe is right action for this family. And if/when an occasion arises and we have to pay – we will reassess – this is the first time in 18 years and boy what a shock to the system to be treated in such a fashion when I am willing to pay full fees.
Dentistry is something in retrospect we should have given more consideration to. And we have paid for 2 lots of orthodontics with two kids and a few other expensive dental treatments with the others. But hey, that’s the decision we took, so we paid what it cost.
I simply can’t believe that this doctor is entitled to discriminate like this – also feel that if I scratched a little further – I may find some kind of insurance loophole between doctors and private medical insurers – that my GP inferred in his mumble of trying to explain why this doctor could take this stance.
I really feel like this type of situation should be exposed.
Thanks again
Leeam
LEEAM @ 156 – I think you’ll find that specialists make more money out of their private patients than their public ones. They get government funding plus money from the insurance company plus possibly more from the patient for essentially the same service. So there is a degree of cross subsidisation occurring.
As to refusing to take privately insured patients even if they are willing to pay themselves – I too was surprised to encounter this lately. Just guessing at possible explanations – they don’t want to get caught in the situation of taking on a patient and then when things look more expensive than first expected (or say the patient loses their job) having an existing patient who can no longer afford the treatment.
Another reason may be that they don’t want the hassle of chasing people who fail to pay or looking mercenary by asking for payment upfront. Or more cynically perhaps its their way of encouraging more people into private insurance as they make more money through private than public patients.
Hi Chris
Yep – hear you – I think you have valid points and I agree – still feel outraged though – something just doesn’t seem right with this situation and it does feel more than simply business management/convenience.
L
Leeam – agree – I find it rather unusual too and think you were treatly rather badly by the receptionist. I wonder if the stand on private insurance is consistent with the ethics that the doctors are expected to follow. It may be that they’ve just had a bad run with patients not paying, but the stance does appear to be becoming more common.
Just out of curiousity – when you get operations done without insurance, do they give fixed quotes or just ballpark figures?
Chris – not really sure, I guess it would depend on the nature of the operation. We once had one quoted by a doctor and he gave ball park figures but said that it would between $ and $. Friends had their vasectomy quoted and the fees were spot on.
I guess so long as one had a good idea what one doctor was likely to charge, I would then get a second opinion/quote before I went ahead with going under the knife anyway.