Public vs Private health a real-world perspective

Public vs Private health a real-world perspective

Yes, you've heard it before, you should have medical insurance and income protection. Well here's a story of exactly why you need to consider insurance cover.

Your life may depend on it.

We have a client who has had ongoing issues with immunity for some time. They have the cover and have been able to access treatment in a reasonably timely way.

However, there is an interesting contrast with the public response.

I'll start with the public response as it has worked and would have played out.

  • Several viral infections and secondary bacterial infections resulting in visits to the GP over 3-4 months.
  • The medical advice from the GP's, and they are good GP's so not casting dispersions on professionalism here either.
  • The GP response, it's reasonable to have 10-12 viral infections per year, and secondary infections needing antibiotics are not unusual. Here's your script for augmentin.
  • That works for a bit, but it's flu season, and something pops up 10 days later. Back to the GP, another script, this time doxycycline as the augmentin may not have managed it fully.
  • All ok for a while and then another viral infection and a trip back to the doctor. Another course of doxycycline.

Then a gap, as this doesn't seem to be working and things just need to be worked through.

  • Then it gets worse, strep throat, now we're talking something more severe and potentially impacting the heart. Back to the GP. This time we're looking at a different approach, roxythromycin for a month. Now we're getting a bit serious.
  • The GP refers to an ENT review. This could take 4 months to get there. Once there a CT scan will need to be arranged, this too could take another 4 months and then back to the specialist.
  • If this were referred in September, the ENT appointment would be somewhere between December and February, Likely February due to the holiday break.
  • Then the CT another 3-4 months, give that by now the sinus issues are likely well gone. Then back to the ENT.

The answer from the ENT was nothing here, no infections, they can tell superficial or deeply embedded with the scans. And no structural issues. So the response from the ENT, nothing to do, back to your GP for management and maybe consider an immunology review with the immune system or perhaps look at allergies.

  • Back to the GP, discuss the situation and referral to immunology, which public wise is a 4-month wait, if at all. Privately it is a 2-month wait.
  • And that is about the extent of the investigations, and ongoing management, now we are back into winter for 2020, is antibiotics and ongoing management like this.

Seems reasonable, right?

Ok, now for the private health response.

  • GP refers to the ENT specialist in September, at the same time, we also progress an income protection disability claim for the client.
  • As this is taking a somewhat retrospective approach, the insurance company wants a specialist review. This is to assess what has gone on and where this sits in terms of disability. So an Occupational Physician review is requested too.

If you've seen the medical drama House, the Occ Physician is basically House.

  • The ENT review is a month away earliest, and they advise that a CT will be needed. Back to the GP to get the CT requested as the specialist won't refer this until they see the client. This is requested and done.
  • As outlined above, this finds nothing. Except we are in early October 2019 and not June-September 2020. Almost a full 12 months faster than the same process in the public system.
  • Because this is not an urgent or critical case, it's not a priority to be seen immediately, so it gets delayed.

A few days later, the Occ Physician review is done. Their comments confirm the experience for the acceptance of the disability claim. However, they also identify that the lungs have not been reviewed.

With the ENT review and the confirmation that the sinus is not the cause of the issue, the usual thinking of sinus to lungs following gravity may not be correct. This means the infection issues may be coming from the lungs, go see a respiratory specialist.

  • So back to the GP for the referrals for the immunologist and the respiratory specialist. Discussing this with the GP, they refer for a chest CT as well. This is the likely next step, too with the respiratory specialist typically following the same path as the ENT specialist.
  • Now, this is where it gets really interesting. We are in the middle of October 2019, the CT is done, and there is an inflammatory nodule in the lower lung discovered. It is approximately 2cm.

It could be a tumour, though the CT review suggests it is more likely to be inflammatory rather than cancer. Which is great news. However, it still could be cancer.

Which brings me to the point of why private health insurance and income protection is critical.

  • The private health insurance on its own would have sped up the process for the ENT and the immunology review. Which is still to be done at the end of November 2019.
    • Edit: The immunology review was done in December 2019, and was found to be normal, as normal as normal gets.
  • The private health insurance would have meant that with the next flu season there is the possibility that the lung review might have been picked up and progressed.

This still means that the investigations on the lungs may not have got to the point of discovery by the end of 2020. And certainly would not have progressed to the chest CT and the present discovery.

  • Edit: Given the events of 2020 it is also likely that the impact of lockdowns and reduced bugs around that the expected issues to be investigated would not have happened in 2020, but when 'flu' season returns or a case of Covid happens.
  • Edit: The discovery has been narrowed down to a piece of Lego. Which is still there and being managed. The client is fit and healthy and back at work, actually better than before they became ill.

This is to say, for this client, it is the combination of medical insurance and income protection that has enabled the right testing and diagnosis to happen. Which is fortunate.

Now in all likelihood, the lesion found is not cancerous.

However, if it was cancerous, there is a genuine chance that the lack of investigation now, and in the past, would have resulted in either finding it too late by discovering lung cancer symptoms and not just infection.

  • Or the delay in finding it means a significantly higher impact on the wellbeing of the individual. And potentially having it be life-threatening or life-limiting.
  • Very scary when you start to discuss and review things in this way.

My question is, do you want to chance these sorts of things and be one of the regular headlines, or do you want to have the right cover in place?

The other aspect of this is having the right adviser, us!

Because we both arrange cover and manage claims, we have a very proactive approach to what can be done. Where we can help speed the process up by getting additional testing requested, we do.

So give us a call today! Right now is good and let's discuss how you can ensure you get the most effective coverage and medical outcomes possible for you when you really need it!

BTW, detail of this case has been discussed and printed with permission of the client involved.

Edit: edits added April 2021.

Jon-Paul Hale

Written by : Jon-Paul Hale

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