APHA: Surgery backlog still serious

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Elective surgery numbers across the nation remain a concern, 18 months after the first COVID-19 procedure shutdown in private hospitals.

Australian Private Hospitals Association (APHA) CEO Michael Roff said it would be some time before the backlog could be addressed. 

“We estimated there were 340,000 episodes of care 'missing' from private hospitals in 2020. 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. 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,” he said.

The latest data from the Australian Prudential Regulation Authority (APRA) shows there were just under a million episodes of care in private hospitals (978,797) in the three months to the end of June 2021. 

“This is more than the previous quarter but will still not make up the gaps in healthcare need created by the various lockdowns around the country,” Mr Roff said. 

The data also showed a 0.1 percentage point increase in private health insurance membership in the quarter, and year-on-year data shows an increase with an additional 245,189 people with hospital cover compared with 30 June 2020. 

“It is encouraging that more people will have access to private hospitals so we can address the surgery backlog when the COVID situation settles. The APRA data shows funds held over by private health insurers to fund elective surgery that could not take place during the pandemic – deferred claims liability – stands at $1.4 billion," Mr Roff said.

“Private health insurers have not made good on their promise to return these funds to members – only $400 million has been handed back in this quarter." 

Mr Roff said this inaction by insurers needed to be addressed.

"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," he added. 

“The APRA report indicates health insurers doubled their profit to $1.5 billion in the 12 months to the end of June. Therefore, the Minister should look very closely at any insurer trying to increase their premiums while still holding onto large amounts of their members' money in the form of deferred claims.”

Read more: Big health insurers ‘should pay back deferred claims’

Read more: Episodes of private hospital care lift as lockdowns end

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