CHA position paper calls for default benefit for Hospital in the home

Catholic Health Australia has released a position paper calling on the Commonwealth Government to extend default benefits to Hospital in the Home (HITH) care, with benefit rates set at a defined relationship to the standard hospital bed day rate.

Default benefits – which set the minimum amount insurers must pay for a treatment – currently do not apply to HITH, leaving many patients who want home-based care unable to access it.

“Hospital in the home is safe, effective, and loved by patients but without a default benefit in place, many Australians simply can’t access it,” said Dr Katharine Bassett, Interim Chief Executive Officer of Catholic Health Australia.

“Extending default benefits to HITH would give hospitals the confidence to invest in the innovative models that patients are asking for while easing pressure on hospitals as demand soars due to population aging.”

The position paper has been formally endorsed by the Hospital in the Home Society Australasia, following extensive engagement. It also draws on a co-design process undertaken by CHA and Bupa to identify the key reforms needed to make HITH a mainstream option for privately insured patients.

The paper comes as the Government prepares a consultation on private health sector reforms. CHA has, and will continue to, engage constructively in that process.

Research on HITH consistently shows lower readmission rates, shorter stays, reduced 30-day mortality, and patient satisfaction above 80 per cent. An independent review has found HITH comparable to in-hospital care on clinical outcomes and self-reported health status, while a report by Private Health Australia estimated that expanding out-of-hospital services could generate up to $1.3 billion in annual savings across the system.

Polling commissioned by CHA found that 82 per cent of Australians would consider HITH if it were offered by their private hospital.

“While other developed nations such as Canada and the UK are soaring ahead with HITH, Australia is stuck in the past due to our outdated regulations. Our proposal would fix that,” said Dr Bassett.

CHA recommends a default benefit anchored to a defined relationship with the standard hospital bed day rate, with benefit rates reflecting the range of clinical complexity across HITH service types. Eligibility for the benefit would be limited to programs operated by, or on behalf of, accredited private hospitals meeting the National Safety and Quality Health Care Standards.

The paper also calls for strengthened governance frameworks and clear protections for patient choice and clinical autonomy, including ensuring that decisions about whether a patient receives care via HITH rather than in hospital rest with the treating practitioner, not insurer.

The proposal is backed by the Hospital in the Home (HITH) Society Australasia.

“The HITH Society Australasia supports calls for a default benefit for HITH care, allowing more patients to access high quality care in their preferred location,” said President Dr James Pollard.

“A default benefit, tied to a common definition of HITH, will support efforts from providers and insurers to give patients the certainty of eligibility, funding, and safety and quality standards in the provision of acute care at home.”

CHA’s position paper is available online.