Young, fit & healthy it may not be the Fountain of Youth, but having great health cover can keep you feeling young, fit and healthy!
In this issue we take a look at how health cover has helped some of our fit and healthy members out of sticky situations; brought the hospital home for some people who really needed it; and helped to make welcoming our newest members into the world a little less overwhelming! Plus, just in case you’ve ever wondered whether health cover is really ‘worth it’, we take a look at the staggering cost of some very commonplace procedures.
Contents
Editor Simone Tregeagle Design Team Scope, scopedesign.com.au The health information provided in be well is intended to be informative only and should be carefully evaluated for its source, accuracy, completeness and relevance for your purposes. It is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional. You should always obtain appropriate professional advice relevant to your particular circumstances. railway + transport health fund ltd (abn 93 087 648 744) is a registered health benefits organisation.
02
from the CEO
04
Improvements to your cover
05
bringing the hospital home to you
08
young fit & Healthy
While it’s true that Australia’s healthcare system is in need of transformation, it’s time to take a closer look at how some of the proposed reforms will affect families, so we can all make informed decisions when it’s time to go to the polls.
Take a look at these new benefits designed to give you and your family more cover, from head to toe.
Our hospital at home program has given many members the opportunity to stay in the comfort of their own homes while receiving top-quality hospital care. We share the heart-wrenching and heartwarming stories of two families who have benefited from this program.
Young, fit and healthy, and wondering if you really need your health cover? Three of our ‘healthy’ members share their stories … and some very good reasons to be happy to have private cover!
How much stuff costs
20
You might want to sit down for this one! We take a closer look at just how much some ‘common’ medical treatments and procedures really cost – the numbers are pretty surprising, to say the least.
11 08
12 16
20
How well do you know your cover? If you’re not as familiar with your health cover as you’d like to be, we have the perfect tools to help you get to know your cover better, and to make sure you’re getting the most from your rt membership.
12
What’s hiding in your family tree
16
Managing your membership
17
Pregnancy, Birth + Beyond
Is your family tree hiding something more sinister than the odd black sheep? We look at how exploring your family history can help you get to the root of potential health issues so that you and your GP can be on the lookout for the telltale symptoms of bigger health problems.
Take a look at these tips and tools for making managing your membership easier than ever.
Having a baby is exciting – but it can be overwhelming as well. Our pregnancy, birth + beyond program is giving expectant parents a little extra support while they work on bringing our newest members safely into the world.
be well 1
from the CEO It’s clear that healthcare will be one of the key platforms on which the upcoming election will be contested – and we are thrilled that health is being given the attention it so desperately needs. Australia’s healthcare system is reaching a crisis point: skyrocketing costs together with unprecedented numbers of people using hospital and medical services are combining to create a looming financial disaster. As a health fund, we purchase healthcare services on behalf of our members and we are keenly aware of the impact created by these two forces as we strive to contain costs and deliver increased value to our members. This issue of be well is dedicated to sharing some member experiences with you that demonstrate the value of private health cover, as we reveal the staggering cost of some common medical services and treatments. While opting to have private health insurance is a matter of personal choice, governments sometimes introduce – or remove – initiatives which make that choice more difficult to make, and this is something that the present Rudd Government is committed to doing. At risk is one of the most significant incentives that many people have for taking up – and keeping – their private health insurance, the 30% rebate. Currently, the rebate is available to all Australians with private health cover, but the proposal being put forth by the government will require it to be means tested. With the income cut-off starting at $75,000 the possibility of the rebate becoming unavailable for many families is very real. Without the rebate, health cover will become increasingly difficult for many families to maintain, but the Medicare Levy Surcharge and Lifetime Health Cover Loading penalties will make it impossible for families to not have private cover. It is obvious that the public system is heavily overloaded – the average reported waiting time to receive treatment for non-life 2
It is obvious that the public system is heavily overloaded – the average reported waiting time to receive treatment for non-life threatening surgery in the public system is currently 100 or more days.
remain healthy the fund costs less to run, which gives us the ability to keep member contributions to a minimum, and makes it easier for more people to have access to the cover they need. Like so many people, we’ll be watching the healthcare debate and proposed reforms with great interest and some concern throughout the lead-up to the federal election.
threatening surgery in the public system is currently more than 100 days*. This is significantly longer than it would take to access treatment in a private hospital, and 80% of patients believe this is an unacceptably long wait. And it is. The government has proposed a new national funding and management approach designed to radically improve the public hospital model, however, this situation is unlikely to change in the short term. Reforms of this magnitude, while laudable, are impossible to implement quickly, if at all, and we face a potential exodus from private health insurance by people priced out of the market and into a struggling public system.
Finally, I’d like to mention our new-look be well. Over the last three years the feedback we have received from you has told us that you find this to be an interesting and valuable resource, and this fresh new format is designed to make it even easier for you to enjoy finding out more about health and your health cover. We all hope you enjoy it. Until next time, take care and be well.
Glenn Campbell Chief Executive Officer
Other proposed government healthcare initiatives are focused on community based primary care – creating facilities where people who do not need to be hospitalised can receive treatment through community health centres – and a commitment to preventative healthcare with a particular focus on decreasing the damaging effects of alcohol, tobacco and obesity. We are supportive of any initiatives focused on keeping people well rather than simply helping them to deal with the issues that arise once they become ill. As a not-for-profit health fund we are not in the business of making money from our members’ ill health, as opposed to the majority of the healthcare system which earns its money when people are unwell – our interests in health are directly aligned with yours. If we can help our members
*Health Care & Insurance Australia 2009. IPSOS Australia
be well 3
We’ve been listening to the things you’ve told us are important to you, and on 1 April this year we introduced a range of improvements to our benefits for optical, dental and orthopaedic shoes – the three most commonly requested changes we’ve received in the past 12 months.
al benefits Great new optic o’ve been wh rs be em m for years. 5+ r with rt fo
improvements to your cover Increased dental limits for members with extras cover.
We’re increasing the number of services you can claim each year for fillings and extractions. Now you can to claim up to eight fillings and six extractions within your ‘general dental’ benefits each year. (Does not apply to Fit + Healthy Extras Cover.)
New benefits for store-bought orthopaedic shoes.
Up till now, our benefits for orthopaedic shoes have been limited to custom-made shoes. Now you can claim up to $200 every two years for off-the-shelf orthopaedic shoes, with a referral from your podiatrist. (Does not apply to Fit + Healthy Extras Cover.)
Increased optical
benefits for members who’ve been with us for five years or more.
If you’ve had rt extras cover for five or more continuous years you’ll now receive 100% of the cost of frames, lenses or contact lenses (including prescription sunglasses and Irlen lenses), and be able to claim up to $300 a year – that’s $50 a year more than members of Medibank Private, HCF or MBF can claim for optical! (Applies to all rt extras covers.)
4
We’ ve removed the excess on hospital stays for children under the age of 16.
If you have hospital cover with an excess, you’ll no longer pay the excess on hospital stays for children under the age of 16.
How would you
like to save a bundle on your next pair of glasses?
Visit OPSM, Laubman & Pank, Budget Eyewear or Vision Plus-WA for a huge 23% discount on your next pair of lenses or frames (including prescription sunglasses), and 15% off contact lenses. To claim your discount, mention that you're an rt health fund member at the time of purchase.
Wow!
Bringing the hospital home to you In 2007 we introduced our hospital at home program, which makes it possible for rt members (with the consent of their doctor and hospital) to choose to receive treatment in their own homes rather than face a hospital stay.
be well 5
Bringing healthcare to people at home means they’re likely to be more comfortable and relaxed, which can improve recovery time and reduce the chances of secondary infections or relapse. And, it’s great for morale, too, as people enjoy a much better quality of life in familiar surroundings with family and friends nearby. This simple idea has made an enormous difference to many rt members, including the Noy and Ryder families, who were both incredibly relieved that their loved ones were able to receive treatment at home, rather than endure lengthy hospital stays. Our hospita l at home p could be su rogram itable for an y hospital st If you’re go ay. member ca ing into hospital give our re te or have a ch am a call on 1300 88 6 at with you r doctor. Yo 123 read more u can and downlo ad the refe enrolment rral and forms you need from our website w w w.r thea , lthfund.com (select the .au ‘r t member s’ sectio click on the page ‘health n and and wellbeing p rograms’).
6
awaited her. The rt team explained that through our hospital program we were able to help with the ongoing rental of a machine that would enable the Noys to return home. Even though they knew it was likely to only be for a short time they returned home where Mr Noy was able to spend those irreplaceable last days in the home that he knew, surrounded by the people he loved. Mrs Noy says that her ordeal was made so much easier by being able to return home with her husband, where they could enjoy the love and support of family and friends. And while devastated by the loss of her husband, she was grateful that she wasn’t forced to face it alone and a long way from home.
When home is the only place to be A hospital stay can be challenging enough if you’re close to home, but what happens when the nearest hospital that can treat you is 600km away? When Yvonne Noy’s husband of 40 years, Charles, was diagnosed with oesophageal cancer in 2008, their devastating situation was made even worse because the local hospital was unable to provide the treatment he needed. Their only alternative was travelling the 15-hour round trip to Brisbane from their home in Gladstone for treatment. Mrs Noy, alone in a strange city and with no support network, was forced to stay in a hotel after long days at Charles’s bedside while she struggled to come to terms with his treatment and prognosis. After one particularly gruelling eight-week hospital stay, the Noys gratefully went home, but a few days later Mr Noy’s condition worsened. With Mr Noy unable to eat or drink, they were forced to return to Brisbane again, where it became apparent that Mr Noy would be dependent on a specialised feeding machine. He faced the prospect of an indefinite hospital stay with his wife having to either relocate to a strange city, or return home alone while he remained in hospital. With no support network and little aid being offered by the hospital bureaucracy, this lovely couple was running out of options when a nurse suggested that maybe their health fund could help. Mrs Noy visited our Brisbane member centre where a cup of tea, a caring ear and all the help she needed
The best of hospital care, home delivered Gregory Ryder was looking forward to playing a few rounds of golf during his retirement. But just a few weeks after retiring, Mr Ryder, who is diabetic, began to have problems with an ulcer on his ankle, which rapidly progressed from being irritating to downright dangerous. Despite four hospital stays and countless doctor’s appointments, the ulcer just wouldn’t heal and Mr Ryder was left with a bone-deep wound the size of a 50-cent piece. Finally, his specialist recommended a lastditch solution – negative pressure wound therapy, which (in basic terms) involves applying negative pressure to a wound with a vacuum pump, promoting cell growth and healing. Unfortunately, it also usually involves an extended hospital stay for the treatment to be administered. Facing eight weeks in hospital, Mr Ryder asked if there was another alternative and was told that the treatment could be provided at home with the right support and homebased care. Within minutes of his doctor contacting rt, an action plan was being created to keep him out of hospital while still providing the care he needed. Although the treatment wasn’t easy, Mr Ryder says that having it at home where he was comfortable, more in control of his treatment and able to watch all the footy he wanted was ‘absolutely brilliant’ – and he couldn’t speak highly enough about the quality of care he received. Better yet, the treatment worked. New cells grew, and although there are still complications, Mr Ryder is confident that his ankle will heal in time.
Do you have a story to share?
If you’ve used our hospital at home program and would like to share your story with other rt members, we’d love to hear from you. Email help@rthealthfund.com.au or mail to po box 1100, burwood north 2134.
be well 7
Young, fit & healthy? Who says you don’t need health cover?
8
If you’re young, fit, healthy and hardly (if ever) use your health cover, you may wonder from time to time if you really need it. But like the three rt members featured in this story, you may find that you don’t actually have to be sick to find yourself in hospital. Could you afford a $6,000 cricket match? Like most blokes, Tony loves his cricket. And while he loves watching the Aussies win, he loves playing it even more. Last year, he was in the middle of pulling off the match-winning catch for his team when the ball hit the tip of his right-hand ring finger, forcing it backward. It hurt (a lot!) and swelled up, but Tony assumed it was just jarred, so he kept it iced. After two days with a still-swollen finger his wife urged him to see a doctor. The news wasn’t good.
Tony had sustained a compression fracture to his knuckle (which basically meant it was squashed). He needed reconstructive surgery to fix it and he needed it fast, otherwise he risked losing the use of his finger altogether. Feeling a little shellshocked, Tony was relieved when he was able to answer ‘yes’ when asked if he had private health insurance and he was sent to see one of the few specialists who perform this kind of surgery in Australia. At the hospital his relief was compounded when he learnt that as a public patient it was unlikely he would have been able to see the specialist in time to save his finger. There’s a very small window of opportunity to fix this type of injury, but because it’s not classed as ‘medically urgent’ public patients are placed on a waiting list. And the latest industry research shows that public patients wait, on average, more than 100 days for admission to hospital for nonlife threatening conditions.
as a public patient it was unlikely he would have been able to see the specialist in time to save his finger.
be well 9
As a private patient, Tony was able to start the process of fixing his finger immediately, undergoing surgery that involved taking a bone graft from his wrist and using it to reconstruct his knuckle with the aid of steel pins. Following the surgery, Tony needed physiotherapy and special splints to provide extra support for his knuckle – and everything, from the original x-rays to the custom-made splints – was covered. Today, Tony has most of the mobility in his knuckle back and is even playing cricket again … but more importantly, he’s able to work. If not for his health cover it’s likely that he would have lost all movement in his finger and because he’s right-handed this would have severely impacted his ability to do his job. On top of it all, after finding out that rt had paid out more than $6,000 for his hospital and medical expenses, Tony’s one young guy who couldn’t be happier that he was covered when the completely unexpected came his way. Keeping a smile on Alex’s dial It’s not just our sporting heroes who need to think about their health cover – what would you do if you found out that your son or daughter, like 13-year-old Alex, needed thousands of dollars’ worth of orthodontic work that you simply couldn’t afford? Or if your child’s perfect pearly whites got knocked out during a sporting match or in an accident? If they’re baby teeth, you’re probably okay, but if they’re adult teeth you’d have to start wondering how much overtime it’d take to be able to afford to get your kid’s teeth back to where they belong. If you’re like Alex’s mum though, all you need to do is 10
give rt a call to find out exactly what you’re covered for and breathe a sigh of relief, knowing that you’ve got everything under control. Alex and his mum are especially lucky that they have Extras Cover with rt. With a lifetime limit of $3,000 for orthodontic treatment, rt’s orthodontic benefits are at least $500 better than most other funds. Getting Ali home for Christmas Then there are the so-called ‘minor’ medical problems that can be debilitating, but aren’t considered medically urgent. Take Ali for example. She was able to have her gall bladder removed instead of suffering for months on a public hospital waiting list. Although the pain is excruciating, gall bladder removal is not generally considered ‘medically urgent’ and the waiting lists are lengthy. Because she had private hospital cover Ali was able to have the surgery within a week of her diagnosis, and that meant she was home for a pain-free Christmas with her family, and able to keep running around after her one-year-old daughter. These are all great examples of young, fit and healthy people who might have wondered if health insurance was important – but it’s safe to say that they aren’t wondering anymore. Health cover is about giving you the options you need for yourself and your family, and it’s the type of control you need more than ever when the unexpected happens. To find out more about what you’re covered for, and if you’ve got the right level of cover for yourself and your family, read more on our website or give our Do you have member care team a call.
a story to share?
If your health cover has helped you out of an unexpected bind and you’d like to share your story with other rt members, we’d love to hear from you. Email help@rthealthfund.com.au or mail to po box 1100 burwood north 2134.
VISIT
.com.au althfund ou e th .r w ww y thing y for ever ow about kn need to lth cover. a e h r u o y
how well do you know your cover? With health insurance, keeping track of exactly what you’re covered for can be difficult. Unlike other types of insurance (like car or house insurance), which cover you for a handful of things, your health insurance helps to pay for a vast number of different products, services, treatments and procedures. The trick to making sure you get the most from your cover is in knowing where to find the right information and making sure you ask us if there’s anything you’re not sure about. These are some of the resources we have available to help you understand your health cover better. Of course, if you’d rather just ask us, we’d love to hear from you!
Detailed cover charts These comprehensive charts explain how your cover works, and provide lots of detail about exactly what you can claim and how much you’ll get back. Copies are available on our website. Visit www.rthealthfund.com.au, select the ‘rt members’ section and click on the page ‘how do you know what you’re covered for’.
The A-Z of rt If you’re looking for information about how your cover works, this should tell you everything you need to know. It’s all the rules, regulations and details, available in online, downloadable or printed format. You’ll find the A-Z in the ‘library’ of our online member centre.
be well The last issue of be well was dedicated to helping you understand more about how your health cover works, as well as giving you the insiders’ tips for making sure you’re getting the best value from your cover. Visit www.rthealthfund.com.au/be_well.html to read it online or to download a copy. If you’d like us to send you printed copies of any of these materials, give us a call on 1300 886 123 or email help@rthealthfund.com.au.
If you’re looking for general information about health insurance and health funds, try these sites: www.privatehealth.gov.au – this government-operated site contains a database of every health cover offered by every health fund in Australia. You can download a Standard Information Statement for any product you’re interested in, and because all funds use the same format for the information, it makes comparing covers easier than ever. www.phiac.gov.au – the Private Health Insurance Administration Council collects and publishes financial and statistical data about health funds, and information to help consumers make betterinformed decisions. One of its key publications is a very helpful little booklet called Insure? Not Sure? It’s a handy guide to private health insurance and definitely worth a read if you’re still deciding whether or not private cover is best for you. www.phio.org.au – the Private Health Insurance Ombudsman is an independent government agency that provides advice to consumers and mediates complaints. They have a range of useful materials available, including the annual State of the Health Funds report which gives consumers information to help them make decisions about private health insurance. www.health.gov.au – private health insurance policy is set down by the Commonwealth Department of Health and Ageing. Its website has a wealth of information about the government’s key health programs and services, and useful resources to help people make informed decisions about their health and wellbeing.
be well 11
What’s hiding in your family tree? If you look closely, in most families you’ll find a ‘black sheep’ – the oddball relative who fascinates the rest of the family and is usually spoken about in hushed tones. But what if the branches of your family tree are hiding something more sinister?
12
be well 13
Visit our website to read more h about heart healt
.au/be_well.html ww w.r thealthfund.com n 2009 issue for and click on the autum rmation. info lth more heart hea
The autumn 2009 edition of be well featured an article about ‘silent’ heart attacks. It was a story that started alarm bells ringing for many people, including rt director, Victoria Reynolds. As she read about the symptoms of an a-typical heart attack, the type more likely to be experienced by women, Victoria realised that she had been experiencing similar symptoms herself, but they hadn’t seemed quite serious enough to warrant a trip to the doctor: feeling tired, short of breath, and generally not quite ‘right’. As a 57-year-old mother and grandmother, business owner, board member and professional consultant she rationalised that she was probably just tired, and maybe carrying three to five kilos more than she should. She decided to do something about it, so she joined a gym to improve her fitness, increase energy levels and drop a couple of kilos. One Saturday following a gym session, Victoria began to feel unwell but she’d made arrangements to go shopping with her granddaughter, Jazmine, so she had a brief rest and went ahead with her plans. While shopping, she began to feel more seriously unwell – dizziness, a racing pulse, clamminess and a dreadful sensation of ‘heaviness’. She started to suspect that the pain she’d been experiencing in her right shoulder wasn’t the result of having slept on it uncomfortably, but of something far more serious. Victoria drove herself to the nearest ambulance station, knocked on the door and told the paramedics that she thought she was having a heart attack. She was put in an ambulance and tested immediately with equipment that sends results to a specialist who then advises paramedics of appropriate treatment while the patient is being transferred to hospital. At the hospital, Victoria underwent extensive tests, which 14
Without her private cover there’s a very real possibility that she may have had to wait for the surgery and been unable to choose who performed the procedure or even where it was performed.
revealed that she had not only suffered a heart attack, but that she had likely also suffered a previous attack up to a year earlier. Just 48 hours later she was undergoing triple bypass surgery. While this sounds terrifying the reality is that Victoria was lucky – her rt cover enabled her to have the surgery immediately with the surgeon and hospital of her choice. Without her private cover there’s a very real possibility that she may have had to wait for the surgery and been unable to choose who performed the procedure or even where it was performed. Instead, Victoria was able to choose the time, the place and the surgeon and her hospital cover made the $42,000 procedure possible. After 24 hours on life support and ten days in hospital, Victoria returned home to face some of the most challenging weeks of her life. Most people who experience serious heart events report feeling ‘overwhelmed’ by the sheer enormity of the experience, as well as having difficulty concentrating, a lack of appetite, and an inability to sleep, all of which make the simplest tasks exhausting. Many people dismiss their symptoms as ‘silly’ but they are very real and dealing with them is a significant part of the recovery process, which can take up to six months. In retrospect, perhaps the most frightening thing is that neither Victoria nor her GP considered the possibility that she was ‘at risk’ for heart problems. As a non-smoker with a healthy diet and a busy lifestyle that kept her constantly on the go, she simply didn’t fit the stereotype. Determined to find the source of her condition, Victoria began researching her family history and what she discovered was quite alarming – grandparents, cousins, uncles, and even her own brother, had experienced serious heart-related problems. Armed with this new information about her family’s medical history, Victoria feels much more comfortable about being assertive
when she goes to the doctor and asks for what she feels she needs. And she says that she listens to her body more now as well – resting when she needs to and investigating those ‘niggling’ problems rather than simply pushing on as she used to do. Victoria is now compiling her own family medical history to help her children and grandchildren avoid such potentially lifethreatening situations. Having adequate information about your family’s medical heritage is vital to giving your doctor everything he or she needs to be able to help you identify your health risks. The Centre for Genetics Education is a program of NSW Health which operates out of Sydney’s Royal North Shore Hospital. Its website provides a wealth of information about genetic health issues, including a range of tools and advice for gathering and documenting your family health history. Visit www.genetics.com.au.
The silent attack The common misconception is that women have fewer heart attacks than men but this is simply not true – they are just less likely to experience ‘classic’ symptoms and are therefore less likely to recognise it for what it is. They are most likely to put their symptoms down to menopause, tiredness, muscle pain or indigestion. In Victoria’s case, her doctors found evidence of a prior heart attack that likely occurred up to a year before the one that led to her surgery – and she had no idea that it had happened.
Can we help you stay healthy4life?
If you’ve experienced a heart event, or if you are someone at risk of heart disease, our health4life program might be able to help. If you have hospital cover with rt, it’s available to you at absolutely no cost. A professional medical case manager will work with you one-on-one for up to 12 months to help you make positive health changes in your life and adopt the healthy habits that will help you to better manage your condition. Read more on our website where you can download additional information and an enrolment form, www.rthealthfund.com.au.
According to the American Heart Association journal Circulation, the most frequent symptoms of heart attack in women surveyed were: – Shortness of breath 58% – General weakness 55% – Unusual fatigue 43% – Cold sweat / feeling clammy 39% – Dizziness 39% – And most frighteningly, in 43% of cases there was no chest pain at all.
be well 15
Visit
.com.au ww w.rthealthfund er rtn pa a to set up authority for . your membership
managing your membership Do you have a ‘couples’ or ‘family’ membership? A simple 'partner authority' can give both adults named on your cover the same level of access to make enquiries, sign claim forms and advise us of changes to your membership. The way your cover is set up is that one person is always named as the 'primary member', and that person has all the rights to manage the membership. The other adult named only has that same level of entitlement if a 'partner authority' is granted. With a 'partner authority' in place both adults can do everything needed to manage the membership, with the exception of being able to cancel – only the primary member can do that. To check if you have a partner authority in place – and to very easily add one if you don't – log in to our online member centre where you'll see your partner authority status right there on the entry screen. Visit www.rthealthfund.com.au and click on ‘member login’ at the very top of the screen.
Have you tried our new online claim form? Our new online claim form enables you to complete your details on screen, saving you from having to fill in the form by hand, and preventing us from misreading your handwriting. Once complete you just print, sign and send in the form. Download your next claim form from the ‘handy forms’ page in the ‘rt members’ section of our website, www.rthealthfund.com.au.
Thanks for your time In February we conducted our fourth annual online member satisfaction survey. Close to 10% of our entire membership responded to the survey, which was sent to everyone who we have a current email address for. Each year the survey has provided us with invaluable insights into what we’re doing well and what you’d like to see us improve. We’ll keep you posted about the results, and new initiatives coming from the feedback you’ve provided, in the coming months. 16
regnancy, birth+beyond As the old saying goes ‘every pregnancy is different’, which explains why it can be so hard to find out everything you need to know about yours from a book! There are times when you really just need someone to talk to. It’s natural for parents-to-be to have questions and concerns, even if it isn’t the first time they’ve been expecting. rt now offers a program designed to make pregnancy, birth + beyond a little easier by giving you access to a team of midwives for unlimited phone and email consultations; five scheduled one-onone telephone appointments with a midwife; a range of practical books and a comprehensive website packed with information about each stage of your pregnancy; and handy information about caring for your newborn baby.
The program is designed to give you a guiding hand from conception right through to baby’s first birthday, helping you to enjoy a stress-free pregnancy as well as adjust to the changes and challenges that come with having a baby. Even if you’re a little closer to the end of your pregnancy than the start, it isn’t too late to take advantage of this great program. Our dedicated team of midwives are there to offer expert advice and a little old-fashioned reassurance to help you sleep easier at night, even after your new bundle of joy arrives!
be well 17
Here’s what some of rt’s newest members (and their mums!) have to say about the pregnancy, birth + beyond program. Georgia, Rob and Sophie Georgia and Rob have been rt members for just over a year and were thrilled to discover that their new health fund offered such a fantastic program for parents-to-be. As a first-time mum, Georgia says she felt much more confident about her pregnancy and birth knowing that she had an extra resource to call on in between her scheduled obstetrician visits. She enjoyed the feeling of support that came from having a team of highly experienced midwives monitoring her progress over the course of her pregnancy. Being able to pick up the phone and talk to a pregnancy and childbirth expert whenever 18
she wanted made an enormous difference, as any ‘little’ concerns (which plague all expectant parents) could be put to rest easily with quick access to some good advice. Georgia says that the midwives were always incredibly understanding and patient, and their expert knowledge was invaluable in helping her prepare for the birth of her gorgeous baby girl, Sophie. Now that she and hubby Rob are settling into their new family routine, it’s comforting to know that the resource will still be available to help them with the changes they’ll go through during Sophie’s first year of milestones. Georgia has no hesitation in recommending the program to other parents-to-be as a wonderful resource that provides that extra bit of confidence and support during a time when even the smallest changes can be hugely worrying.
have Do you share? y to ancy, a stor r pregn
Photo of Grace and Ben by Photography Inc.
ou and e use d If you’v program tor y d n o y e s b r + u o th y bir are ke to sh ers, we’d love would li b m e m rt er mail with oth ar from you. E .au e h o to nd.c m healthfu help@rt to po box 1100 or mail 2134. d north burwoo
Grace, Pat, big sister Ashley, and baby Ben When Grace discovered she was pregnant with her second child she contacted rt to find out what pregnancy-related services were included in her cover. After hearing about the pregnancy, birth + beyond program she thought it sounded like a great idea. As this wasn’t her first pregnancy, she felt confident in the beginning about what to expect, but she soon discovered that the old adage is true: every pregnancy is different.
brought on by severe morning sickness, and needed some good advice about the best ways to build up her strength once she was able to return home. Grace said she felt more confident knowing that she had access to this additional resource during her pregnancy. Now that her beautiful new baby boy is at home getting to know his big sister, she’s looking forward to the ‘beyond’ part of the program as well!
Although Grace found the written materials useful, she didn’t have a chance to call the midwives during her pregnancy – because they always seemed to call her just when she’d thought of something she needed to know! She did enjoy being able to ask them about things in between her doctor’s appointments, especially as she had to be hospitalised at one point due to dehydration
Are you having a baby?
The pregnancy, birth + beyond program is available to members with Private Hospital Cover. If you’re looking forward to welcoming a new family member, give our member care team a call to find out more or visit our website for more information and an enrolment form.
be well 19
How much stuff costs Have you ever wondered what it costs to have heart surgery, a hip replacement or even to deliver a baby? Australians are lucky to enjoy an excellent standard of medical care, and because we have a working public system and affordable private cover, we’re rarely confronted with the full cost of the procedures we sometimes need to keep us healthy.
20
Spinal surgery (with rehab) $51,484
Pacemaker $23,201
Appendectomy $12,264
Hip replacement $36,432
Natural childbirth $7,109
Caesarean birth $10,163
Knee replacement $24,347
Coronary bypass (with rehab) $51,146
Angiograft and valve surgery $105,467
be well 21
Once you’ve handed over your Medicare or health fund membership card you may never have to think about the cost again, and even if you are left with some out-of-pocket expenses they’ll only be a fraction of the full amount. Even simple procedures can be breathtakingly expensive. Healthcare is one of the great hidden expenses, but just because you never see the bill doesn’t mean there isn’t one – and realising how much you haven’t had to pay can really make you appreciate what you’ve got. In announcing that private health fund contributions would increase in April this year, the Minister for Health and Ageing reported that the benefits paid to (and on behalf of) health fund members had increased by 9.3% in the 08/09 financial year to $11 billion, and they look like increasing by a similar amount in the coming year. In our case, the benefits paid to rt members in the past five years have increased by around $20 million. 22
When you start to understand the costs involved in many medical procedures, you can see how easy it is to stack up these types of numbers. In the 08/09 financial year, our single largest claim was close to $110,000 – for a heart-related condition – and that was just the hospital’s expenses. Doctors’ and other associated medical fees were in addition to that. The cost of our top ten claims alone was around three-quarters of a million dollars. If you’ve ever wondered whether having hospital cover is worth it, consider what some of these common procedures cost. – Hip replacement $36,432 – Knee replacement $24,347 – Natural childbirth $7,109 – Caesarean birth $10,163 – Appendectomy $12,264 – Spinal surgery (with rehab) $51,484 – Pacemaker $23,201 – Coronary bypass (with rehab) $51,146 – Angiograft and valve surgery $105,467
As a not-forprofit health fund we are fortunate to not be under additional pressure to try and build in corporate profits or shareholder dividends on top of it all.
These figures are all taken from actual member claims and while costs will vary depending on individual doctors and whether there are any complicating factors, they represent the low end of the ‘ballpark’ costs for such procedures. Most people are (not surprisingly) staggered to find out the costs of these types of healthcare services, and amazed when they realise how much their hospital cover has paid on their behalf following a hospital stay. We do a number of things to manage the costs of healthcare to the extent that we can, including participating in a consortium of health funds to negotiate best-value contracts with hospitals and doctors, closely monitoring the cost of claims, and where possible, making alternative healthcare options available to members through our hospital at home program. But ultimately, as consumers of healthcare services, we are constantly treading the difficult path between keeping contributions affordable
for members and managing the everescalating costs of the healthcare services our members are receiving. As a not-for-profit health fund we are fortunate to not be under additional pressure to try and build in corporate profits or shareholder dividends on top of it all. Today, around 75% of people with health insurance in Australia are covered by a ‘for profit’ health fund. And when you consider the challenge of trying to build profits into members’ contributions in the face of escalating healthcare costs, it’s no wonder that funds like ours are able to offer significantly better pricing to members. In fact, rt’s top hospital and extras cover saves members between 30% and 40% compared to what members of the four largest funds in the country pay for a comparable level of cover – without forgoing any quality of cover or service.
be well 23
you Got a great story s? mate ur yo ll te love to
saved you a If your health cover has ected happened, for tune when the unexp erience that exp an or if you’ve had t that you’ll never leaves you in no doub love to share it. ’d we drop your cover, Send your story to .au help@rthealthfund.com or mail to po box 1100 4. burwood north nsw 213
health management programs Can we help you stay healthy4life? If a doctor has diagnosed you with a chronic disease and/or multiple risk factors for developing a chronic disease, our health4life program can help you make the changes you need to improve your health and your quality of life. Chronic diseases include (but are not limited to) conditions such as asthma, diabetes, arthritis, depression, cancer and heart disease. And they can often have profound effects on a person’s physical, emotional and mental wellbeing, making it difficult to carry on with daily routines and relationships. The positive news is that in many cases, chronic diseases can be ‘managed’, and sometimes even prevented, by adopting specific behaviors and making lifestyle changes. But we know this can
24
be difficult to do alone. With the health4life program you’ll be assigned a personal case manager who will work with you over a six or 12-month period, depending on the severity and complexity of your condition, through a series of telephone consultations. You’ll receive information about your condition and assistance in developing strategies to help manage it through positive health behaviors. The health4life program is available absolutely free to rt members with any hospital cover who have served the minimum two-month general services waiting period. Call or email us for a referral form or download one from our website, www.rthealthfund.com.au, click on the ‘rt members’ area and select the page ‘health and wellbeing programs’.
We don’t profit from our members. Today, almost three-quarters of all Australians with private health insurance are covered by ‘for profit’ funds. This is a significant change in the health insurance industry, which up until the last couple of years was almost entirely notfor-profit. For profit funds face increased pressure to deliver profits and dividends, together with the constantly escalating costs of healthcare. There is little doubt that it will be their members who will foot the bill. We exist to serve our members, not to profit from them.
be well 25
Pass it on Because you’re an rt health fund member, your immediate family are also eligible to join even though they may not work in transport or electricity. So do them a favour and introduce them to rt’s great value health covers today!
Tell ’em Australian Financial Review’s Smart Investor magazine has named rt one of the ‘nation’s best-value health funds’ for two years running. (2008+2009)