1. AHIA ANNUAL CONFERENCE 2006 INDUSTRY VIEWS ON THE IMPLEMENTATION OF BROADER HEALTH COVER : A PRIVATE HOSPITAL VIEW CHRISTINE A GEE NATIONAL PRESIDENT AUSTRALIAN PRIVATE HOSPITALS ASSOCIATION

2. BROADER HEALTH COVER APHA National PresidentAPHA National President CEO Toowong Private HospitalCEO Toowong Private Hospital Commissioner, Australian Commission on Safety and Quality in Health CareCommissioner, Australian Commission on Safety and Quality in Health Care

3. BROADER HEALTH COVER Minister’s rationale for changes: “these will be the first big changes to health insurance legislation since the early 1990s and should allow insurers to provide policies that reflect contemporary clinical practice and greater convenience for patients.”

4. BROADER HEALTH COVER Increased burden of chronic disease Lack of awareness of how chronic disease is treated now “Remove the artificial (financial) incentive for hospitalisation in the private sector, where a clinically appropriate alternative exists.” (DoHA Directions paper)

5. BROADER HEALTH COVER Role of Outreach services “The current outreach service program (hospital in the home) is a prime example of a mandatory system that is not working. Fund experience suggests that while this system was an attempt to shift high cost patients into a lower cost setting it has added to health fund outlays rather than reducing them.” (AHIA Position Paper March 2006)

6. BROADER HEALTH COVER APHA supports the concept of Broader Health Cover but holds some concerns around the development of the detail of the proposals and their implementation.

7. BROADER HEALTH COVER BROADER HEALTH COVER APHA’s concerns APHA’s concerns: 15 month hiatus before a ‘uniform’ quality and safety regime is introduced Exact shape and nature of ‘uniform’ quality and safety regime to operate from July 2008 Little evidence that Department has a clear grasp of the current accreditation system 40 separate quality and safety regimes to fill the vacuum?

8. BROADER HEALTH COVER BROADER HEALTH COVER Exposure Draft of the Private Health Insurance Bill 2006 Over 200 pages (and still not complete!) 4 lines on quality – detail to be covered in Regulations no details of the promised ‘uniform’ regime for quality and safety

9. BROADER HEALTH COVER BROADER HEALTH COVER “In my 25 years in this area, there’s been increasing concern that wherever medical services are delivered, they should be accredited”; and that “to think with the improvement in sedation techniques we’re getting patients having more and more invasive procedures in unlicensed rooms is to me a huge worry and a catastrophe waiting to happen.” (Merrilyn Walton 4 Corners 23 October 2006)

10. BROADER HEALTH COVER BROADER HEALTH COVER What APHA has proposed What APHA has proposed: the uniform safety and quality requirements must apply to all facilities, service providers (practitioners) and services. This is particularly relevant when many of the services proposed to be covered by BHC products would not necessarily be delivered within a ‘facility’. any accreditation requirement must apply to all services funded under BHC (including for example, telephone advice lines) in both the public and private sectors

11. BROADER HEALTH COVER : APHA’s proposals (cont) BROADER HEALTH COVER : APHA’s proposals (cont) an assurance that the uniform quality and safety regime will be included in the regulatory arrangements for Broader Health Cover. in addition to the requirement of achieving accreditation by 1 July 2008, APHA proposes that for a service to be eligible to receive benefits under BHC, if it is not already accredited, it must be Certified by an industry recognised accreditation agency by no later than 1 July 2007.

12. BROADER HEALTH COVER : APHA’s proposals (cont) any privately insured service for which benefits are paid should be required to report to appropriate national data collections via each health insurance fund as occurs at present with HCP data (proposals only require hospitals to report, not “Broader” services)

13. BROADER HEALTH COVER : APHA’s proposals (cont) An independent review and evaluation of the Broader Health Cover arrangements should report to the Minister for Health and Ageing by 1 July 2009. This review would encompass, but not be restricted to, such factors as:

14. BROADER HEALTH COVER: APHA’s proposals (cont) the range of products available in the marketplace (potential for even greater complexity/confusion), coverage of the population; the extent of consumer protection and satisfaction with the new arrangements; adequacy of the regulatory regime, in particular the uniform quality and safety arrangements; and the impact on health insurance premiums