Health Insurance Rebates For Day Surgery (Aug 1987)

Health Insurance Rebates For Day Surgery

Lindsay Roberts, FRCS FRACS

Chairman, Australian Day Surgery Council, 1990 – 2000

President Elect, International Association For Ambulatory Surgery 1999

This article was presented in may 1987 at an AAS meeting held in conjunction with the GSM of the RACS. The figures in the tables were those current at that time.

The concept of day surgery is now firmly established and accepted by the Medical Profession, Government and the community as a whole. There has been increasing support for day surgery in the United States of America over the past fifteen years and a generally accepted estimate, both in the United States and in Australia, is that 40%, and possibly more, of all surgery can be safely carried out in day surgery facilities with a high standard of patient care.

The development of day surgery in Australia has regrettably lagged far behind and this is largely due to the failure of Federal and State Governments to recognise the great potential of this efficient and cost effective surgical service. In the past three years, however, a small number of free standing day surgery Facilities have been established in New South Wales, Victoria, Queensland, South Australia and Western Australia. The further development of these Facilities can only occur with appropriate support of Government and the health insurance system.

There are many advantages of day surgery, not only to patients and the medical profession, but also to nurses, health insurance funds and Government. It is the cost effectiveness of day surgery which should appeal to Government and the health insurance industry, and this cost effectiveness is illustrated by comparative costs of patients treated in day surgery facilities compared to the same patients treated in overnight bed hospitals (see Table A). There is a cost saving of $150 – $170 for each patient.

At the present time the private health funds have failed to recognise this cost effectiveness. The basic table provides a rebate of only $90 leaving a large element to be paid by the patient. It is of further interest to note a similar inadequacy of the basic table for private hospital insurance and it is no exaggeration to state that the basic health table is now irrelevant as far as private hospital and day surgery services are concerned (see Table B).

On the basis of these facts, the following recommendations demand consideration:

1. The basic table of hospital insurance be modified to provide a full rebate for day surgery services (facility rebate, plus theatre rebate), i.e. at the level which is currently payable to patients in the higher tables.
2. Consideration be given to subsidising disadvantaged patients (especially elderly patients) for day surgery. N.B. Apart from the cost saving, this would assist in reducing waiting lists. The best example is ophthalmology – Cataract operations with lens implant are increasingly being carried out in the day surgery system.
3. Governments give maximum support to the development of day surgery by avoiding unnecessary legislation and regulations.