Putting members’ health before profit

Easing of government restrictions triggers rebound in eligibility checks for privately insured patients

Image: Members Health

A rapid rebound in patient eligibility checks has been triggered by the easing of restrictions across private hospitals and day surgeries in New South Wales and Victoria.

Members Health’s biweekly monitor of patient eligibility checks in private hospitals and day surgeries showed NSW rebounded to a median of 1.6 per cent higher than ‘normal’ levels during the fortnight ending 11 December 2021.

NSW private-patient eligibility checks bottomed out at around 17.8 per cent below normal levels in the fortnight ending 2 October 2021. NSW scrapped all restrictions on elective surgery on 15 November.

In Victoria, where there has been a much slower easing of restrictions, checks reached a median of 0.2 per cent below ‘normal’ at 11 December 2021 – up from 25 per cent below ‘normal’ a month earlier at 13 November 2021.

Chart: Members Health

“Private hospitals, clinicians and health insurers have been working hard to catch up on demand and get people treated for important procedures as soon as restrictions were eased,” said Matthew Koce, CEO of Members Health.

“It is particularly reassuring to see that some of the strongest bounce backs in care have been for time critical procedures involving diagnosis and treatment of skin conditions and chemotherapy, radiotherapy and immunotherapy for cancer.

“Health insurers are prepared for further rapid increases in demand for surgery in the private hospital setting during the new year.

“Long waits in the public hospital system, combined with more people taking out private health insurance cover, means clinicians in the private sector can expect to be very busy in 2022,” said Matthew Koce.

Eligibility checks are a leading indicator of current and future health care demand. Hospitals conduct checks with health insurers to determine patient eligibility to private health benefits prior to admission. Members Health’s research collated data from 22 individual health insurers covering over 3 million lives.

Members Health is the peak industry body for an alliance of 26 health funds that are not-for-profit or part of a member-owned group, regional or community based. They all share the common ethic of putting their members’ health before profit. Our funds represent the interests of more than 3.9 million Australians.

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