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For what its worth…

As you know in Australia we have a number of Government funded health care schemes.

Heres a direct quote from one of my plans.

The danger of not providing for future funding for private multi-disciplinary allied health services reviews and consultative services is that an assumption needs to be made that government funding will continue to always be available at the same level for all clients currently eligible for health services.

It also needs to be assumed that the 'eligibility criteria' (i.e., to access the service) will not change in the future.  In my experience working across all three (3) organised sectors of the Australian Health Care Setting (public, private and non-profit) since 1993, I have witnessed clients experience the following difficulties in consistently accessing appropriate services:

·         Eligibility criteria for many services are inflexible and can change without general community consultation suddenly leaving the client with no option for alternative services;

·         Clients in the 'maintenance' phase are not considered a high priority for on-going services;

·         Changes in government funding and legislation can affect levels of funding and service provision; - (this happens regularly)

·         Access to multidisciplinary services are difficult in remote areas;

·         Essential positions may not be filled when an allied health professional goes on extended leave (due to funding freezes) or a position is vacated – the client is then left without a service;

·         Funding levels may not increase as demand for the service grows, therefore, services become less accessible and waiting lists grow;

·         A 'one size fits all' care prescription or equipment prescription is made as service providers in the public sector are unaware of funding availability, access to private services or more specialized equipment;

·         If a client experiences a negative experience with a particular service or service provider their choice to access other private services is limited due to lack of funds and they feel that they either have to 'put up with a service' they are not happy with or no longer access a service at all;

·         Government services and insurers are trending to adopt 'preferred provider lists' that ultimately limit consumer choice if a private provider chooses not to apply for a position on that list or does not meet the funders criteria or adhere to their philosophy of service provision;

·         It is well known amongst experienced private providers that 'preferred provider lists' are generally made up of therapists who are happy to receive and follow direction from the 'funding body', therefore, essentially completely eliminating access to professional independent evaluations (i.e.; if the provider disagrees with the funding body over a professional recommendation, that provider no longer receives referrals – or the case is removed from them all together – they may then even be blacklisted by the funder and their livelihood is subsequently threatened);

·         People with brain injury are at present excluded from government funded mental health services as they do not meet the criteria and, therefore, require private cover;

·         Individual lifestyle needs are often not catered for due to stringent government policies or legislation that are not flexible;

·         Navigating paperwork required to access government funded services can be difficult and time consuming with any disputes process taking months to resolve;

·         Government services generally attract heavier non-compensable caseloads for their workers, limiting the amount of time allocated to each client.  In my experience most rehabilitation health interventions need to be timely to be effective.  An untimely health intervention can potentially be disastrous for the client; and

·         Many very experienced practitioners move to the private sector for various reasons and are no longer available to publicly funded clients even though they may share a long working history and knowledge regarding that particular client.

In citing the above issues, I in no way mean to disrespect the current team of allied health care workers associated with proving existing government local/outreach services.  It is; however, important to outline the difficulties that health care workers continue to face when delivering an outlying service within a shrinking public health budget to Grant over a number of years (i.e., over the next 50 + years).

This is a real reflection of my experience of what happens as Governments simply cannot sustain free or subsidised health care to a growing and ageing population over a long period of time without a significant rise in taxes – which everyone protests about so it doesn't happen.

As we know coverage issues are frequently contentious, can be changed at any time, may

not  cover the total needs of the patient ( eg number of PT sessions a year) and do not

Cover many areas of need.  Moreover, until a period of time has passed it is unknown what

effect this will have on Policy costs and deductibles as more healthy people are needed to

Cover the sick.  At present the Insurance companies have a safeguard built into the bill,

However, this can change and of course the bill can be altered and most likely will be.

Eg. no way to know at present the true inflationary cost of policies over time and if

Cutting back coverage will be needed to control this. That being said it is incumbent

Upon us to examine all issues.