The Australian government will soon implement a new four-tiered system to make private health insurance simpler for some 13 million consumers, but some doctors and patients said the “arrogant” changes could hit less wealthy hard.
Starting April 1, the new health insurance tiers – gold, silver, bronze, and basic – will be enforced, and will affect all existing 70,000 private health insurance policies in the country.
"I don't think they're going to simplify anything at all; in fact, I think they're going to make it more confusing," Russell Schneider, former health insurance lobbyist, told 9news.com.au.
Matthew Scott-Young, a spinal surgeon whose field will be one of the most impacted by the reforms, said the changes won’t deliver the reliability and certainty people like with their insurance.
The silver category will cover basic spinal treatments, but for costly procedures such as spinal fusion surgery, gold policies will be required.
"The analogy would be that a lady who was pregnant came into hospital to deliver their child through natural birth, but unfortunately there was a complication such that a caesarean section had to be done and they found out they weren't covered," Scott-Young told the news website.
Forty-five-year-old construction veteran Ben Lonnie suffers from severe back pain and requires three discs to be replaced. He currently has mid-range cover costing $191 a month that covers spinal fusion surgery; but under the changes, he would need to upgrade to top-level gold cover, which he can’t afford.
"I don't think it's fair, the level of arrogance for one person or a group of people to say, 'This whole bunch of people can't have their procedure, but all you rich people up here can'," Lonnie told 9news.com.au.
Schneider, one of the architects of Australia's private health insurance landscape during the past three decades, said the system needed to be returned to the old structure, where there’s just one level of cover for everyone.
"Australia's got the best healthcare system in the world. Unfortunately, what's happening at the moment is the health funds are stripping value out of the product and making it less attractive to take it out," Schneider said.
Schneider said the system must also get rid of the gaps consumers have to pay even when they have cover, by ordering hospitals to restrict doctors from charging any more than the agreed health fund benefit for a procedure.
"Don't bill the patient extra," Schneider told 9news.com.au. "If the hospital wishes to pay the doctors more to attract the doctors to that hospital, they're free to do that, but the patient wouldn't pay anything out of their pocket."