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.

Just out of curiousity - when you get operations done without insurance, do they give fixed quotes or just ballpark figures?

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

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.

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

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.

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?

“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 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.

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…

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

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?

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.

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.

That seems like a pretty silly statement.

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-a