Medibank was pleased at the comments Prof. Brian Owler made about the important role of the private health industry in his speech today at the National Press Club and in particular the value insurers can add through involvement in primary care. This is an area that Medibank has been very active in and worked closely with a broad cross-section of health providers on our chronic disease and integrated care programs CareFirst, CarePoint and CareTransition.
However, Medibank was disappointed at the comments Prof. Owler made regarding Medibank’s contract negotiations with Calvary Health Care.
Firstly, our discussions with Calvary Health Care do not change our members’ health cover. Importantly, members can still attend a Calvary hospital after 31 August and Medibank will continue to cover a large portion of their hospital costs. However, members may face an increase in out of pocket costs as Calvary will be able to charge their own rates.
We’d also like to correct any potential misunderstanding regarding our treatment of maternal death associated with childbirth. This tragic and very rare event, which is classified as a sentinel and reportable event by the Australian Commission on Safety and Quality in Health Care (ACSQHC), has been an inclusion in the contracts Medibank has agreed with hospitals for some time.
Most hospitals would not entertain the idea of charging a health fund or a bereaved family for this unfortunate event. In the unlikely event that a hospital chooses to charge a grieving family, Medibank would encourage the family to contact us and we would vigorously advocate on their behalf for the hospital waive the bill. If the hospital still insists on charging, Medibank would of course ensure that there is no out of pocket paid by the bereaved family.
While we are currently negotiating its inclusion in our contract with Calvary Health Care, we understand it is a common industry practice not to pay for this event – because it is rarely charged by a hospital.
This extremely unfortunate sentinel event is not included in the list of highly preventable adverse events that we are negotiating with Calvary Health Care or other hospitals.
We are not afraid to say that we want to see preventable events eliminated from the healthcare system and one of the ways we seek to do this is through our contracts. Medibank does not think it is reasonable for our hospitalised members to fall and receive a head injury, to develop pressure sores or have implements left inside them after surgery. We want this to stop - which is why we have created a link between the care our members receive in our contracted hospitals and our payments to these hospitals.
We expect the hospitals to take responsibility for these events and to pay for them, not our members. These preventable events relate to less than 1% of all hospital separations so, contrary to Prof. Owler’s comments, this is not about the money. This is about making sure that our members do not come to harm while receiving healthcare.