A recent advertising campaign from the federal government promotes private health insurance to people on the basis that they may be able to receive rebates for services in the home, such as dialysis and chemotherapy.

Nice thought, but there are currently no patients receiving private health insurance rebates for dialysis in the home. Moreover, insurers have no offers to cover this treatment.

Today’s reality is that private health insurers are not providing rebates for dialysis patients in any private clinic or hospital setting without severe limits on the amount of rebate paid, and the number of members eligible for treatment. Those next in line are discriminated against, and are forced onto public hospital waiting lists.

The largest three funds in Australia, Medibank Private, Mutual/HBA and MBF, all limit the number of their members who can receive dialysis through a private service.

They do so by placing a cap on the number of members they will rebate at a negotiated level, and then only offering the legal minimum payment of $170 per treatment (called Band 1) for any others seeking treatment. The Commonwealth Department of Ageing and Disability in its “State of Our Public Hospitals Report” June 2005, put the cost of dialysis at $440 per treatment.

Patients are either required to meet the cost difference themselves, about $130 or more per treatment, with an average of three to four treatments required each week, or wait for a public facility. Most health insurance companies stipulate in their agreements with private service providers that their members not be charged the gap. The only option for those patients is to join the wait for public services — the consequences for many are severe: renal failure and emergency hospital admission.

Two simple changes are required to remedy the situation. Firstly, the rebate for dialysis needs to be closer to the cost of the service. The Minister is in a position to direct that the rebate be changed from $170 (Band 1, the default payment) to $303 per treatment (Band 4). Secondly, the funds need to remove the caps they are placing on their members receiving dialysis treatment.

Until such time as these two measures occur, public hospitals will be overloaded with patients requiring dialysis and private providers of dialysis services will not provide any new facilities or be able to offer services to people in their home.

If the rhetoric of the advertising campaign is to become reality, Tony Abbott needs to require the private health insurance funds to pay for their members to receive dialysis treatment. Otherwise, there will be no home-based option, or sufficient community based services for privately insured patients who need dialysis in Australia.

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