Public Hospital Doctors gearing up for a productive meeting
DR ROD McRAE, CHAIR, AMA COUNCIL OF PUBLIC HOSPITAL DOCTORS
As part of our busy schedule, the Council of Public Hospital Doctors will be meeting on 20 April. As always, there are many issues to discuss and we can’t cover them all, but a couple of the more topical ones we’ll be looking at are:
Private patients in public hospitals
Whilst private health insurance is a topic unto itself, patients can be lawfully treated privately in a public hospital by a doctor who has private practice privileges as a workplace employment condition. They may be admitted through the ED, referred from a GP’s or a specialist’s rooms, or be eligible for third party payments.
In March, the Independent Hospital Pricing Authority released its report: Private Patient Public Hospital Service Utilisation.
Key findings of the report include:
- the number of separations in public hospitals funded by private health insurance has almost doubled from 451,591 in 2008–09 to 814,702 in 2014–15 (i.e. an average increase of 10.3 per cent per annum);
- there is considerable variation in the proportion of public hospital separations funded by private health insurance between jurisdictions from 2007–08 to 2014–15 with QLD (an 8.1 per cent increase) and TAS (a 5.1 per cent increase) experiencing larger growth; and
- a number of practices have developed encouraging patients in public hospitals “to elect” to use their private health insurance if it happens they possess it, including job descriptions for private patient liaison officers, and websites promoting the savings to the public hospital from patients electing to be treated as private patients.
The report concludes that there is sufficient evidence that the national Activity Based Funding model has not been a significant driver in the upward trend in privately funded public hospital separations.
It’s an interesting trend and we’ll be looking at this issue with a view to developing a position on it, as it now appears such patient elections are a major revenue line for all public hospitals.
Public/Private Partnerships in Hospitals
This is another growing issue, with a chequered history and many implications for public hospital doctors.
Public-private partnerships are gaining some traction in Australia, with recent developments such as Sydney’s new Northern Beaches Hospital developed under such arrangements.
Public/private partnerships can have a variety of forms, including:
- a private company takes responsibility for both building a hospital and providing maintenance on the building for a 20 – 50 year period. The jurisdictional government saves paying the full capital costs up front and it reduces the immediate debt burden on the State’s balance sheet; and
- private-sector management takes responsibility for all aspects of service provision in the hospital, including clinical care.
The stated benefit is usually that private management will more thoroughly drive efficiency because of the desire to generate its profits.
A main issue for both the AMA and ASMOF is that of identifying the employer, which has profound industrial implications, including accountability of government as an employer, the award under which staff will work, and the transferability of entitlements from previous State Government employment.
Public-private partnerships are typically long-term, with complex contractual arrangements setting out the responsibilities of the parties. They have regularly attracted criticism from Auditors General in several States. Some have been returned to public control, code for being a failure.
Facts we know are that this is a growing phenomenon, and it doesn’t always work. We will be taking a careful look at both the industrial implications but also the clinical care implications, of these partnerships and discussing how they have affected, and are likely to affect, public hospital doctors all around the country.
I look forward to engaging with as many public hospital doctors as possible on these and other important issues as they arise. I also look forward to seeing as many of you as possible at National Conference in Melbourne in May.