Challenging the status-quo of health

I would like to discuss two important areas when it comes to managing your well-being – that of preventative health and how we are helping our members with the affordability challenge.

I often think about the future of health delivery in Australia and about creating a sector where the model of care is centred around the person and not the system.

Research shows us time and time again that we have a population that is ageing or living with high rates of chronic illness like heart disease, diabetes or obesity.

This has resulted in further burdening of our health system by presenting more frequently at emergency departments and often waiting months or years in discomfort or pain to access elective surgery.

The benefits of private health insurance is that you can side-step these lengthy waits for elective surgery and in some instances the public emergency departments, however, there are accessibility and affordability issues across both the public and private sectors where money is often thrown at “more beds” or “over-priced prostheses” rather than getting to the root of the problem.

Wouldn’t it be great if instead of treating the cause and ending up in hospital, we could treat the early symptoms of the disease before it becomes life-altering?

Countries like Singapore do this well, with the health system set up to identify early warning signs of ill health.

For example, if I was to visit a GP in Singapore and my blood work showed that I was pre-diabetic, I would be referred to a diabetes clinic to learn about the illness and how I could reverse the risk factors to improve my health.

It is doing the hard yards and making lifestyle decisions before it becomes a necessity.

This is healthcare at its best – identifying or preventing illness to decrease the burden of disease and its associated risk factors before it impacts on our life.

Often, we are reluctant to engage in our health until we have a health scare or it is discovered through a check-up that something is not quite right.

Your doctor may tell you that you are overweight and as a result, you go on a diet to maintain your body weight, but how many of us make that decision without intervention?

I liken our current behaviours and structure of health to a bushfire and backburning.

We know the damage a bushfire can do if it rages out of control and how much money it takes to rebuild communities in its aftermath. However, we know that if we were to backburn, the risk of bushfire decreases, and it could potentially save our communities.

In the same way, we need to start investing money into actions people can take to mitigate illness, rather than just paying the damage bill.

This is why St.LukesHealth has implemented a range of preventive health services and tools to help our members be proactive in managing their own health by introducing:

  • Snug, Australia’s first health passport that enables to you to keep track of your health information from the convenience of a smartphone app;
  • Counselling benefit so that those experiencing poor mental health can access care before potentially becoming mentally ill;
  • Gap-Free Preventative Dental so that you are encouraged to visit a dentist before the onset of oral health pain or major dental problems;
  • Nutrition benefit from April 1, 2021, so that you can receive professional advice on how to best fuel your body to live your healthiest life.

We know for change to be enacted and for people to take control of their health outcomes, we cannot do it alone and that it needs to happen at all levels of government, business and community.

But in doing so, we cannot forget those members who are health challenged and need timely access to care and at an affordable price.

From a private health insurance perspective, accessibility to services and affordability of care is high on our agenda and that is why we will be working with government on urgent reform in three key areas:

Reforming prostheses: Australians pay 30 to 40 per cent more for medical devices than comparable countries with health insurers forced to pay more than $10 billion for medical devices over the next five years if the Prostheses List and its regulatory arrangements are not amended. The Prostheses List sets prices for more than 11,000 items with some items highly priced in our nation compared to other countries. Our Tasman Sea neighbours pay less for the same piece of equipment. For example, one bare metal coronary stent is $989 on Australia’s Prostheses List, 51 per cent more than the New Zealand price of $439.50 (NZ$465). This also includes holding multinational medical device companies to account.

Restore the health insurance rebate to 30 per cent: We cannot continue to put more pressure on the health system – both public and private - and as an industry we have called on the Australian Government to restore the rebate back to 30 per cent over the next four Budgets. Restoring the rebate for low and middle-income Australia would make premiums more affordable for people who are paying for the cost of their own healthcare, as well as reduce the pressure placed on the public health system.

Removing unwarranted and outdated regulation: Health insurance is a highly regulated industry that includes limitations on what benefits we can pay and provide a member. Currently, insurers can only pay hospitals for a range of procedures that are obtained while admitted as a patient in hospital. Many of these services – such as rehabilitation and wound management could be performed outside the hospital setting and in your home, ensuring shorter hospital stays and freeing up beds for those who need it.

There is no doubt we have a hard road ahead of us to enforce change, but it is necessary if we want to make our communities healthier and continue to provide a highly regarded private-public healthcare system.

I am optimistic that through these changes, we can create a state where our communities flourish with good health because it is accessible and affordable…Not just physically and mentally, but economically too.

Paul Lupo, CEO St.LukesHealth
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