Safety fears in home hospital scheme

Private hospital operators are warning that the proposed hospital-in-the-home ‘revolution’ could result in health funds lowering the quality of healthcare to cut costs.

Federal health minister Greg Hunt wants to allow private patients to access some hospital services – such as mental health treatments, postnatal care, chemotherapy, renal dialysis and palliative care – at home through their health insurance. He’s also keen to boost the value of private health insurance at a time when younger people are leaving it in droves.

But Australian Private Hospitals Association chief executive Michael Roff told Nine that health funds were pushing a US-style model where private insurance funds dictated which services members could access, and who delivered them.

“They want to make sure they’re controlling the service,” Mr Roff said.

He said private hospitals were subject to rigorous national safety and quality standards that did not apply to non-hospital medical providers or health funds. “The government has to ensure that whatever service a patient is accessing is the right choice for that patient, in consultation with their treating doctor.”

Currently, Australians can claim on their hospital cover only for treatment received in hospital, a rule Mr Hunt said created “perverse outcomes and perverse incentives”.

Catholic Health Australia has issued a report to Mr Hunt arguing that hospital in the home could treat up to 10 per cent of private patients who would normally be treated in a hospital.

“Far too many people are going into hospital every year for care that could be delivered in the comfort of their own home,” said Catholic Health Australia’s director of health policy, James Kemp.

“High-quality care can be delivered safely and effectively at home. We just need the private health insurance industry and the government to work cooperatively on reform that will allow more people to enjoy the benefits,” he said.

“It’s essential that out-of-hospital care does not turn into the poor cousin of in-hospital care. We need patients to be able to trust that the care they receive is the same as in-hospital care, and for this we need national standards on out-of-hospital care and to track the care provided.”

In May, medical experts Martin Hensher, Bodil Rasmussen and Maxine Duke said hospital in the home had already made major inroads.

“In 2017–18, more than half a million days of publicly funded hospital care were delivered at patients’ homes rather than in hospital,” they wrote for The Conversation.

“It provides an alternative to hospital admission, or an opportunity for earlier discharge than would otherwise be possible. The research found it is also associated with a lower likelihood of readmission within 28 days (2.3 per cent vs 3.6 per cent) and lower rates of patient deaths (0.3 per cent vs 1.4 per cent), compared with being an inpatient.”

They said an expansion of the service had been curtailed by the pandemic, but “home service models may be even more valuable in a post-pandemic world”.

“Longer term, the rapid boost to telehealth and remote monitoring technology driven by COVID-19 will greatly benefit hospital in the home.”

They said insurers and private hospitals were likely to be under pressure as members cancelled policies due to unemployment or reduced income. Hospital in the home could prove successful in driving down costs.

Private Healthcare Australia chief executive Rachel David insisted health funds supported the idea of hospital-in-the-home and “a whole lot of people with medical conditions no longer think going to hospital is safe” because of the COVID-19 pandemic. But she said: “Not every program is going to meet the patient’s needs.”

In November 2019, Professor Stephen Duckett from independent think tank the Grattan Institute wrote that receiving treatment at home was more convenient for patients, reduced the demand on hospitals, and cut costs for the health system. But such services were often not available to those with private insurance. He called for the red tape to be untangled “to make it easier for private hospitals and doctors to run these programs and for insurers to pay for them”.

He wanted private hospitals to “lift their game” and submit to the same activity-based funding rules as public hospitals, so insurers did not have to pay for “wasteful” services.

He wanted private hospitals to negotiate with all medical practitioners involved in a hospital stay on the patient’s behalf before handing a single bill to their insurer.

“Private hospitals would have to absorb any excess costs from doctors – or charge patients a declared and upfront fee to cover those costs,” Prof. Duckett said.

At that time, Mr Hunt said the changes being considered would help lower the cost of providing treatment as well as improving patient care.

“The hospital-in-the-home revolution is potentially one of the most significant improvements in the private health offering in the last 20 years,” Mr Hunt said. “These are old rules [that] were put in place 20 years ago for a different medical system and a different time.”

He told state and territory governments and private health insurers he wanted more care delivered in patients’ homes and pledged to make it easier for these services to qualify for funding.

Mr Hunt said his aim was to offer more choice and better clinical outcomes for patients, as well as better efficiency for state and territory health departments and private health funds.

Have you used hospital-in-the-home services? Are you more likely to use such services because of the pandemic?

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