Specialist physicians have sounded a warning that thousands of Australians face a lifetime of chronic pain and second-rate treatment options under the Federal Government’s private healthcare reform.
A group of concerned spine surgeons and other medical practitioners say the proposed policy bands of Gold, Silver, Bronze and Basic will leave thousands of patients having to choose between the spine surgery they need and the one they can afford.
Gold Coast orthopaedic surgeon Associate Professor Matthew Scott-Young said spine surgery was split between Gold and Silver bands under the reforms, with spinal stabilisation and fusion restricted to the top level of cover.
“Splitting funding for spinal conditions between Silver and Gold will result in a patient’s level of private health cover influencing clinical decision making,” Associate Professor Scott-Young said.
“Surgeons will be pressured into offering, and patients will be obliged to accept, suboptimal care based on their level of cover.”
Assoc Prof Scott-Young said the reforms would cause more people to live with chronic pain or to opt for less effective treatments simply because they were the ones they could afford.
“It will increase pressure on the already over-burdened public health system and, ultimately, lead to an increase in the impact of spine disease within the Australian community,” he said.
“There is level one evidence to show spinal fusion is the most effective treatment for a number of elective and emergency spinal conditions. Add to that our 20 years and 6000 patients worth of Patient Reported Outcome Measures data which demonstrates spinal fusion patients have clinically significant reduction in symptoms, with an overwhelming majority able to return to enjoying their everyday activities.”
Federal Health Minister Greg Hunt announced last week that the changes were to ‘empower’ the 13 million Australians with private health insurance by providing a simplified summary of their cover on a single page. Mr Hunt also said the reforms, effective from 1 April 2019, would not lead to a change in policies or a rise in price for private health customers. Private health insurers currently offer top hospital cover as well as spine fusion from as little as $42.70 a week.
Numerous professional medical associations lodged submissions to the Federal Government during its consultation process, highlighting risks and problems with the proposed changes. Concerns about splitting the treatment of a single condition across different levels of cover formed the focus of many submissions. A further round of consultation is underway with submissions due on August 3, 2018.
Dr Bill Sears, Immediate Past President of the Spine Society of Australia and a Sydney-based neurosurgeon, said health fund coverage for spinal surgery should be an all or nothing proposition – you should either be covered, or you should not.
“Australians who choose to take out cover for private spinal surgery are entitled to feel confident that they will receive the procedure that is best suited to their problem,” Dr Sears said. “Things may change at the time of surgery; patients must be assured that they are covered for whatever eventuates and that their care will not be compromised.
Their surgeon shouldn’t have one hand tied behind his or her back.”
Sydney neurosurgeon Dr Marc Coughlan warned the reforms could have ‘draconian consequences’ on thousands of Australians.
“It would potentially impact the lives of thousands of patients who would be precluded from having spinal fusions because of the high costs of the prostheses,” he said.
“Many of these people are younger patients with spinal conditions impacting on their ability to walk, work and remain productive in the workforce.
“My concern is that practitioners will be forced to opt for less effective procedures that in many cases will ultimately lead to multiple operations and increased costs.”
Sydney neurosurgeon Associate Professor Ralph Mobbs said the millions of Australians who have paid for private health insurance for decades – in the face of annual premium increases – deserved to receive the coverage they had been promised.
“Those who have invested for private health insurance for years have a legitimate right to expect the treatments they previously had for the same premium,” Dr Mobbs said.
An estimated 3.7 million Australians have chronic back problems and more than $1 billion in total health care expenditure in Australia is attributed to the condition, according to the Australian Institute of Health and Welfare (AIHW).
In a 2017 report, AIHW found back pain and back problems were the third leading cause of disease burden in Australia.
Gold Coast spine surgeon Assistant Professor Laurence McEntee said public hospitals would feel the weight of thousands of spine surgery patients who were no longer able to receive the care they needed in the private system under the reforms.
“There were about 12,000 people who had spinal fusions in the private system in the past year,” he said. “Offering spinal fusion only in the most expensive level of private health cover will trigger a massive cost shift to state governments because we will see a drastic increase in the number of people moving to the public system for treatment
where there are already waiting lists of up to three years for spine surgery in some regions.”