Private Health Funds Research Articles

The 'Sic Vos non Vobis' of Interventional Radiology - Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand.

The 'Sic Vos non Vobis' of Interventional Radiology - Rebranding and modernising the Interventional Specialities of Radiology in Australia and New Zealand.

Increased private health fund involvement in Australia's primary health care: Implications for health equity

AbstractThis study identifies current practices of private health funds (PHFs) in Australian primary health care (PHC), including areas where their involvement is increasing, and examines the risks and benefits of these practices for quality of, and equity of access to PHC. The paper draws on research to investigate equity implications of current PHF involvement in PHC in Australia. We reviewed literature, analysed documents relating to a Senate Committee inquiry and interviewed stakeholders and experts in private health insurance policy from government, private sector and nongovernment organisations. Involvement of PHFs in the PHC sector in Australia is increasing, presenting risk of increased inequities in access to PHC based on insurance status, which could undermine the universality of PHC under Medicare. However, some stakeholders think these risks can be managed within current policy arrangements. There are also risks for quality of PHC services arising from greater involvement of PHFs in service delivery and “preferred provider” models. Differing stakeholder views on equity implications of PHF involvement in PHC are associated with different views on desirable policy action. We conclude that there is a risk of increased involvement of PHFs in PHC risks exacerbating existing inequities in the health system, but this is moderated by public support for Medicare.

The non-medical surgical assistant in Australia: who should contribute to governance?

Objective: This paper focuses on the role of the Non‑Medical Surgical Assistant (NMSA) in Australia. Registered Nurses predominately perform this role. This paper will articulate a position to: validate this role as an Advanced Practice Nursing (APN) role in Australia through regulation and governance by the Nursing and Midwifery Board of Australia (NMBA) who sit under the umbrella of the Australian Health Practitioner Regulation Agency (AHPRA); lobby AHPRA to recognise, regulate and protect the title of Advanced Practice Nursing (APN) roles other than the Nurse Practitioner (NP) in Australia; and as a result of sanctioned regulation, facilitate APN (including NP) to seek appropriate remuneration for undertaking this role in the private sector in Australia. Setting: The Australian Healthcare system. Subjects: Clinicians performing the role of the NMSA in Australia. Primary Argument: The NMSA is well established with clear mechanisms for governance internationally. This role has been practiced in Australia for more than 20 years, and while clinicians function under the guise of advanced practice, the role is not clearly defined, standardised or regulated. This is partially attributed to lack of sanctioned governance from AHPRA. Conclusion: While the AHPRA via the NMBA are reluctant to formally recognise and regulate this role, the overwhelming majority of clinicians in Australia are nurses. Without regulation, it is difficult to quantify the role as APN. Lack of governance excludes NMSA (including the NP) from access to the Medicare Benefits Schedule and private health funds for intraoperative reimbursement thereby rendering a potentially cost-effective role unsustainable to many clinicians.

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

Access to dental care for people with bleeding disorders: survey results of hemophilia treatment centers in the U.S.

The goal of this project was to gather data and identify factors affecting access to dental care for people with bleeding disorders in the U.S. The Arizona School of Dentistry & Oral Health and the National Hemophilia Foundation conducted a joint survey. The survey was completed by 102 of the 147 hemophilia treatment centers (HTCs) in the U.S. This represents 69% of the HTCs in the country. Each HTC provided specific information concerning the dental services and education provided for patients. Survey results revealed inconsistent levels of oral health services available to patients. Major factors limiting access to care include finances, patient anxiety with respect to dental treatment and a lack of providers with the skills to treat this population. Improvement in oral health for persons with bleeding disorders requires appropriate education for providers, patients and families. Additionally, both public and private health funding must be re-evaluated as it relates to people with bleeding disorders.

Financial fraud in the private health insurance sector in Australia

Purpose– The purpose of this article is to explore financial fraud in the private health insurance sector in Australia. Fraud in this sector has commonalities to other countries with similar health systems but in Australia it has garnered some unique characteristics. This article sheds light on these features, especially the fraught relationship between the private health funds and the public health insurance agency, Medicare and the problematic impact of thePrivacy Acton fraud detection and financial recovery.Design/methodology/approach– A qualitative methodological approach was used, and interviews were conducted with fraud managers from Australia’s largest private health insurance funds and experts in fields connected to health fraud detection.Findings– All funds reported a need for more technological resources and higher staffing levels to manage fraud. Inadequate resourcing has the predictable outcome of a low detection and recovery rate. The fund managers had differing approaches to recovery action and this ranged from police action, the use of debt recovery agencies, to derecognition from the health fund. As for present and future harm to the industry, the funds found on-line claiming platforms a major threat to the integrity of their insurance system. In addition, they all viewed thePrivacy Actas an impediment to managing fraud against their organizations and they desired that there be greater information sharing between themselves and Medicare.Originality/value– This paper contributes to the knowledge of financial fraud in the private health insurance sector in Australia.

Cost Benefit for Assessment of Intermediate Coronary Stenosis with Fractional Flow Reserve in Public and Private Sectors in Australia

Fractional Flow Reserve (FFR) is a proven technology for guiding percutaneous coronary intervention (PCI), but is not reimbursed despite the fact that it is frequently used to defer PCI. Costs incurred with use of FFR were compared in both the public and private sectors with the costs that would have been incurred if the technology was not available using consecutive cases over a two year period in a public teaching hospital and its co-located private hospital. FFR was performed on 143 lesions in 120 patients. FFR was < 0.80 in 37 lesions in 34 patients and 25 underwent PCI while 11 had CABG. It was estimated that without FFR 78 lesions in 70 patients would have had PCI with 17 patients having CABG with 35 additional functional tests. Despite a cost of $A1200 per wire, FFR actually saved money. Mean savings in the public sector were $1200 per patient while in the private sector the savings were $5000 per patient. FFR use saves money for the Federal Government in the public sector and for the Private Health Funds in the private sector. These financial benefits are seen in addition to the improved outcomes seen with this technology.

Australia's private health insurance industry: structure, competition, regulation and role in a less than 'ideal world'

Australia's private health insurance funds have been prominent participants in the nation's health system for 60 years. Yet there is relatively little public awareness of the distinctive origins of the health funds, the uncharacteristic organisational nature of these commercial enterprises and the peculiarly regulated nature of their industry. The conventional corporate responsibility to shareholders was, until recently, completely irrelevant, and remains marginal to the sector. However, their purported answerability to contributors, styled as 'members', was always doubtful for most health funds. After a long period of remarkable stability in the sector, despite significant shifts in health funding policy, recent years have brought notable changes, with mergers, acquisitions and exits from the industry. The research is based on the detailed study of the private health funds, covering their history, organisational character and industry structure. It argues that the funds have always been divorced from the disciplines of the competitive market and generally have operated complacently within a system of comprehensive regulation and generous subsidy. The prospect of the private health funds enjoying an expanded role under a form of 'social insurance', as suggested by the National Health and Hospitals Reform Commission, is not supported.

The funding of private hospitals in Australia

Private hospitals are an essential component of Australia's complex mix of public and private health funding and provision. Private hospitals account for 34.3 per cent of all hospital separations, and over half (56.2%) of all same-day separations. The revenue (funding) of the sector approached $4 billion by 1998/99, and as a result of its recent rapid growth capital expenditure in the sector was nearly $550 million in the same year. Private casemix of private hospitals is distinctive, and characterised by a high proportion of surgical procedures in general (48.1 per cent), and more than a majority of all services in such areas as rehabilitation, orthopaedics (shoulder, knee, spinal fusion, and hand surgery), alcohol disorders, same day colonoscopy and sleep disorders. This chapter synthesizes data from a multitude of sources to produce a comprehensive picture of Australia's private hospital sector and its funding. It examines the funding (revenue) sources of private hospitals, and considers how and why private hospitals approach the issue of funding from a different perspective than their public sector colleagues. To illustrate how Australian private hospitals approach revenue (funding) strategically, a series of indicative types of hospitals is explored.

«Science and the stuff of life»: modernist health centres in 1930s London

In the inter-war period there was a dialogue between modern architecture and planning and the concerns of health reformers and practitioners. This paper examines that dialogue in the context of two health centres built in London in the 1930s—the Pioneer Health Centre (1935) and the Finsbury Health Centre (1938). Both of these buildings are landmarks in the history of British modernism and they share that movement's concern with hygienic design, the utilization of sunlight and fresh air, and the value of propaganda in health education. However, they differ in their ideological or social programmes. Whilst the Pioneer Health Centre expressed a conservative belief in private health funding and the family, the Finsbury Health Centre was part of the radical regeneration of the Borough according to socialist principles of State funding and citizenship. The paper ends by considering what these examples tell us about the history of modernism.