Funding Puts System Under Stress, While 28,000 People Wait
The Age
Wednesday November 1, 1995
ALAN Hughes, the executive director of the Victorian Hospitals Association, said recently that about two per cent of the population in Victoria is dropping out of private insurance schemes each year, and at the same time the Government is cutting back on funding.
Inevitably this increases the pressure on public hospitals.
``Cuts have been too great in too short a period, (and) the real worry is that medical people under stress will make more mistakes, and the VHA is watching this situation carefully, " Mr Hughes said.
Public hospitals provide 24-hour care and the majority of the most sophisticated diagnostic equipment is located in public hospitals, said Mr Hughes. Consequently even patients who are privately insured are often treated in public hospitals.
However, private patients do not jump queues, and there is no evidence that people are moving back towards private insurance because of the stresses on the public system. Mr Hughes said this, in part, is because they can't afford to or are young and healthy.
While few Victorians would not be aware that there have been radical changes in the State hospital system, and there are continuing concerns about waiting lists for hosptial beds, those fortunate enough not to be on such a list are probably not clear about the current situation.
Mr Hughes explained that the Government has an elective services performance bonus fund which is alloted to each hospital and based on that hospital's current waiting list. Targets are then set for the number of patients to be treated and the time frame in which that must happen.
About 28,000 patients are now awaiting surgery in Victoria.
They are categorised according to the severity of their condition.
Those with life-threatening conditions are in category one, those with serious but not life-threatening diseases are in category two and those who have conditions which are inconvenient rather than serious and could be remedied by surgery, but can be maintained without it, form the third category.
Mr Hughes said the penalties for not achieving the bonus fund targets can be savage, citing category one patients who have to be attended to within 30 days. Failure to do so results in the bonus being reduced by 20 per cent for every patient who waits longer than that.
While Mr Hughes claims that with few exceptions no one in category one is waiting for more than 30 days, but the number of patients in category three is increasing.
In a ``battlefield" situtation, patients are assigned to surgery by a method known as triage, where the most urgent are dealt with first. Each surgeon takes a new patient every time he or she finishes operating on the last. This method might bring patients to surgery more quickly, but it ignores the break up of surgery into specialties and the patients' desire to have the surgeon of their choice doing the operation.
Surgeons who practice in areas where patients have conditions which are almost always extremely urgent experience log-jams, with the numbers building up and up.
Mr Hughes concluded that the private and public hospital systems are out of balance. He believes that in a few years' time the hospital case-mix will be funded in both public and private hospitals and that private hospitals will care for public patients paid for by the Government, blurring the line between the two. He said: ``I think that would be a good outcome, not unlike the Canadian system. There may even be provisions to make a certain surcharge on patients who earn above a certain amount and who don't have private insurance."
How the funds measure up
MBF HOSPITAL COVER
Effective from 3 October 1995
Hospital
Services 100%
Extras 60% Hospital Services
(Excess on 100% - Extras 80%
Excess Services Hospitals (Excess on Hospitals
Level 100% Cover Services only) Services only)
Nil
Excess $15.35 $21.50 $23.05
$100 $14.00 $20.15 $21.70
$200 $12.65 $18.80 $20.35
$300 $11.50 $17.65 $19.20
$400 $10.95 $17.10 $18.65
Please 100% cover for MFB will pay 100% MFB will pay 100%
note: accommodation & accommodation & accommodation &
Other theatre costs theatre costs theatre costs
excess in MBF Vic. in MBF Vic. in MBF Vic.
options Agreement Agreement Agreement
are av- hospitals.* hospitals.* hospitals.*
ailable Includes & up to & up to
up to emergency 60% normal 80% normal
$1000 ambulance charge charge of
per home care of extras, extras, with
person as part of with optional optional excess
per an on-going excess for for hospital
year. hospital pro- hospital serv- services only.
gram, public ices only. Dental and
hospital Dental and Pharmaceutical
accommodation Pharmaceutical limits increased.
surgically im- limits increased.
planted pros
thesis & schedule
fee gap.
(Table cont.)
Excess Hospital Services Hospital Services
Level 100% - Extras 60% 100% - Extras 80%
(Combined Excess) (Combined Excess)
Nil excess $21.50 $23.05
$100 $19.20 $20.75
$200 $17.60 $19.15
$300 $16.20 $17.75
$400 $15.35 $16.90
Please MBF will pay 100% MBF will pay 100%
note: accommodation & accommodation &
Other theatre costs in MBF theatre costs MBF
excess Vic. Agreement** Vic. Agreement
options hospitals* & up to 60% hospitals* & up to
are av- normal charge of extras, 80% normal charge of
ailable with optional excess extras, with optional
up to which applies to both excess which applies
$1000 services. Dental & to both services.
per Parmaceutical limits Dental & Pharmaceutical
person increased. limits increased.
per
year.
*Prices are based on a single weekly auto pay rate. **These are
hospitals that have entered into a contractual agreement with
MBF.
Please note that waiting periods apply to all hospital & extras
services. Annual limits for extras will apply.
IOOF
Effective from 1 April 1993
Weekly Premium Basic Cover Intermediate Cover Top
Cover*
(Family is double) $9.15 $13.35 $18.50
Treatment
Classifi Duration of Shared Private Shared Private
cation Admission Ward Room Ward Room**
Advanced Surgery
First 14 days $245 $330 $370 $440 $470
After 14 days $169
Obstetrics
First 14 days $224 $330 $370 $440 $470
After 14 days $169
Medical
First 14 days $196 $330 $370 $440 $470
After 14 days $169
Special Psychiatry
First 42 days $224
43-65 days $196
After 65 days $169
Rehabilitation
First 49 days $224
50-65 days $196
After 65 days $169
* IOOF also provides excess tables for the four levels of cover.
The cover includes 100 per cent cover in participating hospitals.
** Wards and rooms dependent on length of a stay and hospital
category. For intermediate, top and 100% cover, duration of
admission days vary. Ring fund for confirmation.
MEDIBANK PRIVATE
Effective date May 1995
Blue Ribbon
Weekly Basic Intermediate Hospital
Premiums Hospital Hospital (100% Cover)
Full
Benefit Family Single Family Single Family Single
$20.04 $10.02 $24.90 $12.45 $29.90 $14.95
$300/$150 Excess - - $20.66 $10.33 $25.66 $12.83
$500/$250 Excess - - $18.16 $9.08 $23.16 $11.58
In Members' Shared ward up Shared $50 100% Cover
Choice Hospitals to $235 Private $80
Capped at $280
In other private Shared Shared Shared Private
Hospitals Ward Ward Ward Room
Treatment $ up to $ up to $ up to
Classification
Advanced Surgery $235 $330* $388* $418*
General/Obstetrics $215 $300* $363* $393*
General Medical $188 $235* $240* $270*
Special Medical $188 $250* $265* $295*
Psychiatric $215 $300* $362* $382*
Rehabilitation $215 $300* $362* $362*
* Benefits are slightly reduced in hospitals not accredited
by ACHS
HBA HOSPITAL COVER
Effective from 10 October 1995
Level of cover Basic Cover Intermediate Top Cover
Cover
Weekly Premium $22.70 $28.90 $38.20
Cover in any HBA Up to $245/day *100% Cover 100% cover
Participating less an excess
Private Hospital of up to $200
per hospital stay.
No excess will apply
after 3 hospital stays
in any one year.
**Cover in other Duration Basic Intermediate Cover
Private Hospitals of Admission Cover or Top Cover
Benefit up to: Shared Private
Ward Room
Advanced First 6 days $245 $355 $385
Surgery 7-14 days $245 $265 $295
After 14 days $169 $169 $169
General First 4 days $224 $315 $345
Surgery 5-14 days $224 $250 $280
After 14 days $169 $169 $169
Obstetrics First 8 days $224 $315 $345
9-14 days $224 $250 $280
After 14 days $169 $169 $169
Medical First 7 days $196 $285 $315
8-14 days $196 $224 $245
After 14 days $169 $169 $169
Psychiatric First 7 days $224 $285 $315
8-21 days $224 $235 $265
22-42 days $224 $224 $224
43-65 days $196 $196 $196
After 65 days $169 $169 $169
Rehabilitation First 49 days $224 $285 $315
50-65 days $196 $196 $196
After 65 days $169 $169 $169
**The cover listed under ``Other Private Hospitals" only applies
to 15% of the total number of private hospital beds in Victoria.
85% of private hospital beds are in HBA Participating Private
Hospitals and attract higher participating hospital benefits such
as 100% Cover. Special bonus benefits are now available with 100%
Hospital Cover and 100% Hospital Cover with Excess, Contact HBA
for details.
AUSTRALIAN UNITY HOSPITAL COVER
Effective from 1 October 1995
Intermediate Intermediate Private 100%
Family Basic Hospital Hospital Hospital Hospital
weekly Cover (no obstetrics)
$31.00 $29.00 $35.50 $38.60
$23.20 (without (without (without (without
excess) excess) excess) excess)
$27.70 $25.80 $31.30 $33.60
($105/$300 ($105/$300 ($105/$300 ($105/$300
excess) excess) excess) excess)
$28.50 $30.20
($250/$500 ($250/$500
excess) excess)
Treatment
Classification
Advanced $245 You pay a You pay a You pay a max You have
Surgery max $55/day max $55/day $15/day hosp. no out-of
hospital hospital charges. pocket
charges. charges The above expenses
The above The above benefits for hosp.
benefits benefits apply in charges.
apply in apply in Australian The above
Australian Australian Unity Agreemt benefits
Unity Agrmt Unity Agrmt Private apply in
Private Private hospitals. Australian
Hospitals. Hospitals. Tables cover Unity Agmt
Table covers Table covers all treatment Private
all all classificns. Hospitals.
treatment treatment Table
classificns. classificns. Covers all
Treatment
Classifics
**except for
obstetrics
© 1995 The Age
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