Why privately insured patients are paying the price for bureaucratic delay

In marking Heart Valve Disease Awareness Week, two leaders from opposite sides of the operating table – one in scrubs, one in strategy – confront the bureaucracy that impedes timely access to essential patient care.

Professor Jayme Bennetts, Director of Cardiothoracic Surgery at the Victorian Heart Hospital and Monash Health, and Pat Williams, Vice President and Country Manager ANZ/Korea at Edwards Lifesciences, unpack how the clinical landscape in heart valve disease has shifted over the past five years and why progress in innovation does not always equal progress in access.

The assumption that private healthcare guarantees the newest technology in patient care is put under the microscope, as is Australia’s standing against other OECD nations when it comes to adopting global best practice.

“Often the private system is behind the public with regards to accessing new technologies because of the delays through the Prescribed List (PL) process,” explained Professor Bennetts. “So the irony is that the newer technologies are often available earlier in the public system…”

Clinicians are increasingly forced into difficult conversations, explaining to privately insured patients that they must either join a public hospital waitlist or cover the funding gap for TGA-approved technologies delayed in the reimbursement process.

While a recent Productivity Commission report confirms that the spending on novel health technologies has been ‘worth it’ by delivering net benefits to society, how should these types of independent evidence be more effectively leveraged in funding negotiations for cardiac innovations?

“The question shouldn’t be ‘what does this cost today?’ We should be asking what future costs does this avoid?” emphasised Williams. “A lot of these technologies have the capacity and capability to save the government money – not there at the time of the surgery or the intervention, but ongoing to societal value.”

Now in their second term and well positioned for a likely third, the Albanese government has a long runway to pursue meaningful health reforms. The question is, which bold commitments will feature on the Health Minister Mark Butler’s radar in the May budget.

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