Why one Aussie had to rely on Private Health Insurance to receive prompt medical attention
The Australian health system is usually lauded as one of the best in the world. All citizens have access to public healthcare, no matter their income, but they can also sign up for private health insurance (PHI) if they so choose.
But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.
A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.
One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.
‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.
‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.
‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’
‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.
‘I now have the highest level of PHI and regretfully probably will for life.’
Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’
Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’
Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.
But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’
The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.
Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’
However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’
Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.
Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.
Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.
The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’
Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’
What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!
But the system is not without issues. Challenges include a shortage of health workers, the uneven geographic distribution of doctors, and the growing demand for care from the ageing population. In the past weeks, we’ve also discussed inadequate Medicare rebates prompting general practitioners to change their payment schemes and forcing patients to pay out of pocket.
A recent post on the social news website Reddit highlighted another problem: long wait lists for elective surgeries.
One Redditor shared their experience of how PHI came in handy after they had a herniated disc. They said: ‘I will preface this story by saying, I wish this wasn't the case, I wish our public system was always there for us when we needed it, but it's not.
‘I'm a healthcare professional with around 12 years of experience. I'd never bothered with PHI, as I loved and trusted our public healthcare system. I also figured if worse came to worse, I could pay out of pocket to go privately.
‘Then, around eight months ago, I bulged a disc in my lower back, which saw me unable to work and in high levels of pain. After trying a conservative approach, I was advised that surgery was now the only option.
‘To my absolute shock and horror, the public waitlist was 3-4 years, and for spine surgery, no surgeon would see me without private health insurance, even with me willing to pay completely out of pocket. Apparently, both due litigation risk and risk of owing tens of thousands if I ended up in ICU.’
‘Unable to bear the thought of waiting the 12-month waiting period for existing conditions with private health insurance, I started to ask around. Luckily, being in the industry, I was able to pull some strings and get a surgeon to take pity on me and I was in for the surgery as a privately paying patient two weeks later. I'm now three months post-surgery and back at work.
‘I now have the highest level of PHI and regretfully probably will for life.’
Many Aussies found the story to be a justification for national health reform. A top comment on the post said: ‘We need a real universal healthcare system. We desperately need to expand Medicare and fix bulk billing and dental care while we're at it.’
Another concurred: ‘Exactly. They need to stop tax-incentivising private health, start paying doctors better through the public system and focus on primary health and preventative measures. But private = profit and that’s what Australia is driven by.’
Others said that the story was a public healthcare fail rather than a PHI win. ‘If the system were adequately funded from staff through to facilities, we wouldn’t have seen this post,’ said one Aussie.
But not everyone is into the idea, with a Redditor saying: ‘You can have whatever level of public healthcare you want - you just have to pay for it. In the words of the fat man, "it comes with a gold plated Rolls Royce so long as you pay for it”... If we aren't happy with paying a high-income tax, then we need to discuss how much you are willing to pay, and then provide the best services we can within that.’
The comment received a strong objection: ‘We could reprioritise where we spend the existing taxation income. Less tax relief for millionaires and those who profit from our natural resources.’ We previously wrote about how 60 millionaires did not pay any taxes in the fiscal year 2019-20, even though everyday citizens were still the biggest source of tax revenue.
Some Redditors called for the rejection of PHI: ‘If everyone refused to get private health insurance, the public system would be significantly better. The more people pay to avoid it, the worse it'll become.’
However, the recommendation is not workable for many Aussies, like one commenter pointed out: ‘Not everyone can afford to refuse to get PHI on principle… We need the healthcare it covers now, not after we reach the top of a months-long or even years-long waiting list.’
Longer waiting times have always been a concern in OECD countries, including Australia, but the COVID-19 pandemic has exacerbated the issue. Non-urgent elective surgeries, which fall under categories two and three in the urgency scale, were suspended in the last two years. Further, hospitals had reduced capacity, with available workers prioritising Covid patients. According to the Australian Institute of Health and Welfare, patients who had to wait more than a year to receive elective surgery increased from 2.8% in 2019-20 to 7.6% in 2020-21.
Not everyone could afford to wait. Patients with heart conditions and cancer need prompt care, of course. But cases like the original poster’s herniated disc, carpal tunnel syndrome, and hip problems also impact the quality of life for many Aussies, with some forced to stop working. Delayed care is costly, but private insurance is also not accessible to the most vulnerable.
Moreover, PHI is not perfect, even if it provides benefits such as shorter wait times, better coverage, and access to more health services. At least 42 per cent of Australians have experienced ‘bill shock’ even with PHI, and 52 per cent did not think it provided good value, especially when patients still had to pay out of pocket.
The original poster also had another advantage - they are in healthcare and have a network they can tap to expedite the waiting process. One commenter said: ‘Surgery really is about who you know and who you reach out to.’
Another agreed: ‘If the OP hadn't had connections, they would still be waiting. You need to both be able to afford private health insurance and have connections to achieve this result.’
What do you think of the story, folks? Do you think the system has to be reformed? Have you benefited from PHI? Share your thoughts in the comments!