When Greg Owens had a stroke on Boxing Day last year and was rushed to hospital, he felt secure in the knowledge that he had good private health insurance.
- People outside Australia’s big cities are asking whether private health insurance is worth the cost
- The peak body for rural health says there may not be value in policies for some rural Australians
- Private Health Australia says coverage offers more flexibility for people
But he now says the annual cost of $6,513 in premiums for top hospital cover is not worth it.
“There was not much difference to a public patient. I was in public ward and the other people were public patients and I did not receive much of a better deal,” Mr. Owens said.
He was treated as a private patient in his local public hospital at Nowra, a two-and-a-half hour drive south of Sydney.
“My wife had to inquire into exactly what I got for my private health, and it was a newspaper, a television, a parking permit and a specialist of my choice,” Mr. Owens said.
“I’m eight weeks after the stroke and I still haven’t seen a specialist, but I have sourced my own specialist that I’ll have to pay for myself.”
Mr Owens said his treatment had changed his mind about whether having private health insurance was worth the cost.
“I’ve been paying into private health with my fund for over 10 years and haven’t got real satisfaction out of the coverage because I haven’t been sick,” he said.
“Now that I’ve become ill I find I’m outside the coverage of their medical treatment. I’ve got to sort it out myself.
“It looks like it’s all going to come out of my pocket.”
The value of private health insurance outside the big cities has been a common theme in the ABC’s Regional Health Project — a long-term investigation that helps people share their experiences in accessing medical care.
An ‘absolute waste of money’
It was a similar experience to retiree Cheryl Ham, who moved from Brisbane to Launceston in northern Tasmania for a lifestyle change.
But when she had an accident on her bicycle and fractured a piece of bone that lodged between two nerves, she soon realized the standard in health care was completely different — despite having paid into a top-shelf private health fund since she was 15.
“Towards the end of 2020, I was referred to an orthopedic surgeon and thought that I would get it fairly quickly because I have been in private health for many decades,” Ms Ham said.
“As the weeks went by, I realized that I was not going to be seen any quicker than a public health patient.”
Now more than two years later, Ms Ham is still waiting for her specialist appointment.
“I just found it completely shocking that you can pay for decades to top private health cover and yet receive no priority whatsoever.”
She was able to find a surgeon in Brisbane who could fit her in, and her private health insurance paid 50 per cent of the fee.
Premiums for her hospital cover are $3,570 per year.
Ms Ham said private health insurance was “definitely not” worth the cost for people who live in regional Australia.
“I just think it’s an absolute waste of money. You’d better save money and fly to a city and get the treatment there.”
Ms Ham has since relocated back to Brisbane, to be closer to accessible health care.
Extras cover ‘impossible to claim’
For Darren Hutchison, who lives 25 kilometers north of Coffs Harbor — a major regional city on NSW’s Mid North Coast — joining a private health fund was a way to dodge an extra tax burden.
The Medicare Levy Surcharge slugs people with more taxes if they don’t have a private health care policy, while Lifetime Health Cover makes insurance more expensive for people over 31 if they do take out a policy.
The surcharge begins when a single person earns more than $90,000 per year, or a couple earns more than $180,000 per year.
A couple earning that amount would pay an extra $1,800 a year in tax.
Mr Hutchison is now 47 and paying premiums of $4,000 annually for a policy for himself and his wife, with extras covering for things like physiotherapy or podiatry.
He said they were both healthy and therefore struggled to see the value in it.
“We don’t claim those sorts of things anyway, because it’s impossible to access in the New South Wales region,” Mr Hutchison said.
“Not a lot of providers that the insurance company list are located where I live.
“There’s plenty of them in Sydney or other major centers but it’s infeasible to go and make an appointment for a chiropractor or acupuncture in Sydney.
“I need to wear glasses, and I’ll claim glasses once a year whether I need them or not, so that’s about $150 per year.”
Is there value in private health cover?
Private Health Australia chief executive officer Rachel David said 758,000 Australians had taken out private health cover in the past two-and-a-half years.
“One of the main reasons that they join a health fund is because they really need control over when they go to hospital,” she said.
“What private health insurance does is it gives you real predictability and control over when and where you have your medical care.”
Dr David said some health funds offered special policies for people in more remote areas.
“Many health funds do cover a portion of that cost for people living outside the cities,” she said.
Dr David said the Medicare Levy Surcharge was “a penalty for people who are on high incomes if they don’t take out private health insurance”, which was appropriate.
“People who pay the Medicare levy surcharge on higher incomes are generally doing better than a number of people who need to use health services frequently.”
But National Rural Health Alliance CEO Susi Tegen said people in regional Australia were increasingly questioning whether private health insurance suited them.
“Many people in rural and remote Australia may have difficulty seeing the value in private health insurance,” she said.
“There are often not any private hospitals in their region and if there is one, it’s very limited with the type of doctors they have. So the choice is meaningless.”
Ms Tegen said many people took out private health cover because they were scared about what might happen if they had a major health issue.
“If it’s a disaster, or an accident or something, you tend to go to the public system anyway,” he said.
Ms Tegen said the Medicare Levy Surcharge was “probably not” fair for people living in more remote parts of Australia, given they were unlikely to be able to access private health services even if they had a policy.
If you can’t view the Regional Health Project survey on your phone, click here.