Elective surgery backlog unlikely to be resolved any time soon

Australians forced to delay elective surgery due to COVID lockdowns could still be waiting for some time, even when the various lockdowns do come to an end.

The Australian Prudential Regulation Authority (APRA) released its quarterly private health insurance statistics for June 2021 on Tuesday and they suggest that the backlog of elective surgery will take some time to clear.

The figures show that a significant number of patients are still waiting for elective surgery, some for as long as 18 months, as a result of the first COVID-19 enforced lockdowns.

Read: How does Australia’s health system rate internationally?

Australian Private Hospital Association (APHA) chief executive Michael Roff said it would still be some time before the elective surgery backlog could be sorted out.

“We estimated there were 340,000 episodes of care ‘missing’ from private hospitals in 2020,” Mr Roff explained. “Taking into account the six months to the end of June, we now estimate that figure has fallen to 290,000, but it will still take a considerable amount of time to work through these cases.

“This is a serious situation for those affected patients and the healthcare system,” he said.

“These are surgeries and other treatments that have been deferred but they will need to be done at some stage and include procedures like total knee and hip replacements or cataract surgery that impact a patient’s ability to move around or to see.”  

Compare Club CEO Andrew Davis says those with private health who are seeking elective surgery will likely have little to worry about post-lockdown.

“People with private health insurance and access to the private hospital system are likely to have their surgery soon after the restrictions are lifted,” said Mr Davis.

“This was certainly the case in 2020, and there is little reason to think that the private system won’t again respond in an efficient way 2nd time around.

“More concerning are people waiting to be seen in the public system where waiting times have blown out and there is no clear path to catch up.

“It is likely that people will wait years for surgeries like hip or knee replacements, particularly as surgeons who work in both the public and private systems catch up with their private patients first.”

According to the APRA figures, there were 978,797 episodes of care in private hospitals during the three months to the end of June.

These figures were higher than the previous quarter, but Mr Roff said that they would still not make up for the gaps in healthcare need created by the various lockdowns around the country.

APRA explained that the industry’s commitment not to profit from the COVID-19 pandemic had seen some private health insurers announce their intention to return surplus funds to policy holders while others were continuing to monitor the situation and exploring their options.

Read: Why Baby Boomers are missing out on health insurance savings

The regulator refused to pass comment on the best method and delivery of returning any COVID-19-related profits, explaining that it was still a matter for each health insurer’s board and senior management to determine.

Private health insurers have so far not made good on their promise to return these funds to members, with only $400 million of a total of $1.4 billion in deferred claims liability handed back.

“This inaction on the part of insurers needs to be addressed,” Mr Roff said.

“The Australian Competition and Consumer Commission has suggested these ‘deferred claims’, which have not been used to address the elective surgery backlog, should be taken into consideration when the health minister considers premium increases.

“The APRA report indicates health insurers doubled their profit to $1.5 billion in the 12 months to the end of June.

Read: The gap in health outcomes for the haves and have-nots is widening

“Therefore, the minister should look very closely at any insurer trying to increase their premiums while still holding onto large amounts of their member’s money in the form of deferred claims.”

The ageing trend in private hospital membership continues, with membership in the 50-plus age group increasing by 122,786 people, compared with an increase of just 70,389 people in the 20-49 demographic.

How long have you been waiting for elective surgery? Have you had a refund from your private health insurer? Which fund are you with? Are you happy with your fund? Why not share your thoughts in the comments section below?

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Written by Ben