Private health funds to stop paying to fix botched surgeries


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PRIVATE health insurers will stop paying for public hospital surgeries that leave policyholders with scalpels or scissors inside them.

Currently a fund, and possibly a policyholder, could end up having to pay twice — once for the bungled surgery and again for the fix.

News Corp Australia can also reveal that with the number of private patients in public hospitals increasing, insurers will seek binding contracts with state governments or public hospitals stipulating quality levels and costs.

Some funds say they don’t know how often they have been paying for operations gone bad, but they intend to find out. Others say that when they do learn of a so-called “never” or “Sentinel” event from a patient, they go so far as to push the surgeon who made the mistake to cover the cost of another surgeon fixing the problem.

Insurers have for several years had no-pay deals in place with private hospitals covering as many as 80 errors and complications. These range from avoidable deaths and operating on the wrong side of the body to infections and pressure injuries.

The largest fund, Medibank, said its approach had reduced “hospital acquired complications” in some facilities by as much as 30 per cent.

“We’ve made good progress working with our private hospital providers on hospital complications and intend to continue to focus our efforts more broadly across the hospital sector to enhance health outcomes for our customers,” said Medibank’s benefits boss David Simpson.

Private Healthcare Australia (PHA) chief executive Rachel David said: “While no-one wants to penalise a struggling hospital, it is important not to inadvertently incentivise a hospital for poor quality. This occurs when a patient is readmitted, or an admission is prolonged because of a medical error and the hospital gets extra money.”


Both Bupa and HCF also said they expect they will soon no longer pay for bungles, following a move by the Federal Government to cut off funding for mistakes from July.

HCF’s benefits head Cindy Shay said that sometimes private patients mistreated in public hospitals had been made to pay twice. To avoid this, HCF had “advocated” on patients’ behalf including by asking the surgeon to do the operation again without charge or asking the surgeon to pay another surgeon to do it if a patient didn’t want to be operated on again by the surgeon who made the mistake.


PHA’s Dr David said that a move towards formal contractual arrangements with public hospitals made sense because “as driving private patients in public hospitals becomes part of the business model of State Governments, volumes are likely to increase”. News Corp Australia has previously revealed the public hospital push to make the privately insured use their cover when being treated in public hospitals, even though the policyholder doesn’t have to.


THE campaign for discounted health insurance is fast closing in on its goal of 40,000 supporters.

About 33,000 people have joined the Big Health Insurance Switch since it launched two weeks ago.

The campaign aims to extra a saving of $400-plus for families struggling with the repeated supersized increases in premiums, the latest of which kicked in at the start of the month.

Campaign organisers One Big Switch said a major survey of supporters had found 75 per cent are making sacrifices to pay their premium, and 70 per cent are considering dropping or downgrading their cover.

To join the Big Health Insurance Switch go to

*There is no obligation to take up any offer. This masthead’s publisher News Corp Australia and One Big Switch will earn a commission from any accepted deals. News Corp Australia is a shareholder of One Big Switch

Online Source: The News

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