Momentum builds for health insurers to properly fund hospital-in-the-home care

Private health insurers must be required to fund hospital care provided at home to deliver better outcomes for patients and the health system, according to Catholic Health Australia.

An Ernst and Young report, commissioned by the Department of Health and Aged Care and now released for consultation, has highlighted the pivotal role default benefits play in giving private health insurance members options around their health care.

“The report vindicates our long held view that default benefits play a critical role in ensuring patients’ access to care. It’s time now to consider how best to expand default benefits to cover services outside the hospital walls,” said CHA Health Policy Director Caitlin O’Dea.

“Crucially, the report notes that out of hospital care is valued by consumers, but that the absence of default benefits makes access to hospital care at home inconsistent.”

Improved technology means patients worldwide – including those requiring dialysis, recovering from cancer or joint replacement surgery, or receiving end-of-life care, among other things – can now get hospital-quality treatment in the comfort of their homes. But Australians are being left behind on this evolution.

In end-of-life care, for example, only 10 per cent of Australian patients are treated at home, compared to 41 per cent in the US and 56 per cent in the UK.

“Private health insurers in Australia can currently refuse to fund out-of-hospital care, which is holding us back. The rules must be changed so insurers are required to fund hospital care in the home just as they are required to fund hospital care in hospitals,” Ms O’Dea said. “

Out-of-hospital care improves patients’ experience, delivers great results and takes pressure off the stretched hospital system.

“Patients will be left wanting unless insurers are required to fund it like they were sixteen years ago. Back then insurers said the rules were too prescriptive and hindered competition, so the rules were wound back. The result has been the opposite to what was intended. “We know many patients, when their doctor says it is appropriate, want to be at home recovering with their loved ones. Instead, they’re at the whim of their insurer. “Patients and their doctors should decide where they receive their care – not the health insurance funds.” The Commonwealth Government has an opportunity to move quickly to explore how default benefits can be extended to support patients receiving hospital care at home. The Government and EY should be proud of the work they have done to:

• Make clear that default benefits play a fundamental role in protecting consumer choice and access;
• Consider ways to standardise terminology, common contract terms and safety and quality requirements to ensure a consistent consumer experience and lower costs;
• Reject any suggestion that default benefits lead to poor quality care; and
• Highlight the role that default benefits play in ensuring the delivery of high quality, safe and effective care.

The paper is available here for industry feedback until Tuesday 15 August