Surgeons say all patients have the right to appropriate health care

Friday 21 August, 2015

The Royal Australasian College of Surgeons (RACS) is extremely concerned that patients are being denied cover for appropriate care and are becoming increasingly confused about what their private health insurance will provide for them.

This follows changes by some private health insurers to arrangements with Private Hospital providers, limiting what they will cover. Other health care providers are threatening to not cover readmissions for treatment of complications after surgical care.

RACS Executive Director of Surgical Affairs in Australia, Dr John Quinn, said that over 60 percent of elective surgery was undertaken in the private hospital sector and this was a vital and substantial part of the way that Australians accessed their health care.

“The Australian health care sector relies on both the public hospitals and private hospitals to deliver comprehensive clinical care for all Australians. It is critical that high quality patient care is maintained and is central to any discussion between clinicians, hospitals and the health insurers,” Dr Quinn said.

“Given the increasing costs of health in all parts of the world it is also vital that the services remain affordable for the Australian community,” he said.

RACS shares the growing concerns that the many health insurance products available are becoming increasingly complex, difficult to understand and confusing to the public.

“What is in, what is out and what are the hurdles to access reimbursements are often impossible to identify.

“This is not reassuring to the community. It is confusing and encourages movement away from the private hospital sector and towards the already overstretched public hospital system.

“Patient care is always improved when continuity of care is highlighted. In surgery this includes pre-operative assessment, operative care and post-operative care.

“Unfortunately all surgery carries some risk and complications do occur. There is no such thing as risk-free surgery – the risk of complications increases for those with other health problems, such as diabetes, high blood pressure or obesity.

It is always best for patient care that any complication is dealt with, at least initially, by the surgeon and the team already involved. Refusing to accept responsibility for complications is not on – from both a clinical and funding perspective,” Dr Quinn said.

RACS has always been strongly committed to improving standards of care. Analysis of results and improving any aspect of care to reduce complications is central to the College’s ongoing audit and quality approach.

“To ensure that we have high quality patient care that is affordable into the future, it is critical that all parts of the health sector address these concerns in a constructive manner,” Dr Quinn said.

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