Private health and day surgery: tiers before hospital bedtime?

AMA President, Dr Kerryn Phelps, said today that proposed changes to contract arrangements between private health funds and private hospitals could leave day surgery patients paying more for their operations.

Dr Phelps said a decision by the Government - based on health fund advice - would eliminate the second tier default benefit, a mechanism that gives small day surgeries and private hospitals greater protection with large private health funds should contract negotiations fail. Specialist areas of care including psychiatric and rehabilitation will also be adversely affected.

"Put simply, if the Government proceeds with these changes, patients who attend day surgeries will pay more out of pocket for their operations than patients who attend larger private hospitals," Dr Phelps said.

"It appears the Government can make the change without legislation through Ministerial determination to take effect from 1 July 2003.

"The AMA is calling on the Government to consult more widely - beyond the self-interest of the health funds - and defer any decision on this issue.

"The abolition of the second tier default system will disadvantage day surgeries and their patients, and will ultimately force day surgeries to close, further pushing up the cost of surgery - all because the funds don't like negotiating contracts with individual doctors who run efficient smaller day surgeries.

"The AMA is aware of instances where health funds, to save time and effort, would rather pay a large corporate private hospital chain $700 per day for day procedures than pay a day surgery $350 to do the same thing in high standard smaller fully accredited facilities.

"The second tier default system was introduced to keep the health funds honest and keep costs for patients down and quality up.

"On this issue, I think the Government should be putting the health of patients ahead of the demands of the big private health funds," Dr Phelps said.

CONTACT: John Flannery (02) 6270 5477 / (0419) 494 761

Judith Tokley (02) 6270 5471 / (0408) 824 306

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