Meeting patient need – a default benefit for hospital in the home care

Catholic Health Australia and its Members have been leading a national discussion on the benefits to patients of expanding hospital in the home (HITH) care for privately insured patients.

HITH is a cost-effective way to provide a better patient experience with clinical outcomes comparable to those in a hospital setting. This has been demonstrated overseas and on a smaller scale in Australia, however HITH is yet to be widely adopted in the private hospital sector. This oversight leads to significant inefficiencies, often meaning patients do not receive care in the setting most desired by them and most economical for the health system.

Polling commissioned by CHA showed that 82 per cent of Australian’s would consider HITH if it was delivered by a private hospital.

So – what is stopping the broad expansion of HITH in Australia? In a word, funding. In-patient contracting between insurers and hospitals is underwritten by a set of Commonwealth Government minimum-prices called default benefits. Unfortunately, successful insurer lobbying in the early 2000’s removed default benefits for HITH.

In practice, this means that it is insurers, not doctors or patients, who choose whether an insured patient can receive care at home. These circumstances have become a severe limitation on the rollout of HITH. By 2025, the UK will be treating 20 per cent of its patients at home and the US 13 per cent while Australia languishes on five per cent.

The insurers themselves have noted that there is $1.3 billion in potential savings for the health system being left on the table every year that HITH is not expanded. But after two decades left to expand HITH funding on their own terms, they have failed dismally to support this critical care pathway for patients.

CHA has been working to build a coalition of stakeholders – patients, doctors and state governments to name a few – to encourage the Commonwealth Government to expand default benefits to include HITH as soon as possible. 87 per cent of Australians believe insurers should be required to fund HITH delivered by private hospitals where a patient and their doctor agree it is appropriate.

HITH is the next great opportunity to improve healthcare productivity and patient outcomes in the private system and take pressure off strained public hospitals. CHA is advocating strongly to the Commonwealth Government not to let this opportunity pass Australia by.

By Alex Lynch, Director of Public Health and In Home Support Policy, CHA