Concerns hospital giant could 'cherrypick' private patients from public hospital

Ramsay Health Care has been granted special access to a Queensland public emergency department (ED) under a scheme that gives the corporate behemoth priority to transfer privately insured patients to its nearby facilities.

Under the trial, set to be rolled out nationally, a Ramsay-employed nurse placed in the ED at Sunshine Coast University Hospital facilitates the transfer of patients with private health insurance.

The Emergency Department Nurse Liaison (EDNL) program, which aims to ease the load on emergency departments, has raised eyebrows in the sector because the Ramsay-initiated trial has allowed one private provider special access to patients.

More than 2,000 patients have already been transferred out of the public system into one of three private Ramsay hospitals in the first 12 months of the scheme.

Ramsay has confirmed to the ABC it has created a similar nurse liaison role linked to Northern Private Hospital in Melbourne's northern suburbs and is coordinating the introduction of similar roles at hospitals around Australia.

Ramsay, which is listed on the stock exchange, reported a half-year net profit of $160.7 million.

Concerns insured patients may feel pressured

Privately insured patients have long raised concerns about pressure from public hospital billing departments to be treated as private patients within public hospitals.

Consumer advocates hold serious concerns an outside private operator could exert even greater pressure.

Health Consumers Queensland chief executive Keith Tracey-Patte said the organisation was worried the trial could lead to "cherrypicking" of high-volume, low-cost patients for private sector treatment, at a time when patients were at their most vulnerable.

"Our fundamental concern is making sure if there's arrangement like this in any hospital, it must be done in a way where people are given an unpressured opportunity to choose," he said.

"We would like to see the evaluation of this pilot include whether people who fit a particular cohort were more likely to move into private than others."

Mr Tracey-Patte said the transfer program should ensure the public system was not just left with the burden of complex cases, and those patients whose condition was within the scope of the private hospital should be offered transfer.

"We would be keen to ensure that how this is set up that a person isn't pressured to choose private over public or vice versa.

"I'd be uncomfortable if there was decision to roll this out more broadly without a full evaluation."

Is it ambulance chasing?

Mr Tracey-Patte questioned how such a program would be received in metropolitan areas where there was a larger mix of private hospitals competing for patient business.

"I completely understand pressure on emergency departments. I doubt this kind of model would work in all environments," he said.

"If this arrangement was to be useful, I would want to make sure it wasn't leading to a preferred outcome for one private provider.

"There's too many opportunities for this to be distorted by market dynamics."

The ABC understands the other non-Ramsay private hospital near Sunshine Coast University Hospital, Buderim Private Hospital run by UnitingCare, was given the opportunity to participate and declined. UnitingCare Qld declined to comment.

The ABC has been told the trial has rankled some of the public hospital-based surgeons, who lost patients they could have operated on as private patients in a public hospital.

Health Economics Research Centre's director Henry Cutler said the scheme was not anti-competitive so long as other hospital operators also had the chance to place a private nurse in the hospital.

"Patients should be made aware that they can be treated in the public hospital for free, or treated in the public hospital as a private patient, or treated in private hospitals other than Ramsay hospitals,"

he said.

Professor Cutler said it could affect the income of some surgeons, but it was unlikely to be significant.

"For most, their private-patient public hospital waiting list is so long that it would merely reduce waiting times for patients, with no effect on their income," he said.

"But this could also have a perverse effect. As surgeons will follow the patients by practising more in private hospitals, less time will be spent on public patients, exacerbating public hospital waiting lists."

Beware private emergency fees: AMA

Australian Medical Association Queensland president Erica Gannon said the idea had merit if it was clinically sound and done with full transparency.

"We know emergency departments are under increasing pressure, and we are dealing with a chronic shortage of staff, including doctors, nurses and allied health professionals,"

Dr Gannon said.

She did not believe it would affect patient choice if options were laid out clearly.

Dr Gannon noted private health insurance did not cover patients treated solely in private hospital emergency departments and then discharged; people were only covered if they were admitted to hospital, and she said patients should be aware of this.

"Patients who do not end up admitted into private hospital may face out-of-pocket fees for the service, which may be why they are attending public hospitals in the first place," she said.

"They should be made aware of this possibility before making any decision to seek treatment elsewhere."

Medical, cardiac and surgical patients transferred

A Ramsay Health Care spokesperson said it was working with local public hospitals, and patients were only transferred when "clinically appropriate and with patient consent".

Transfers have included medical, cardiac and surgical patients.

"The program … is an excellent example of the public and private sectors working together to improve patient outcomes and help relieve pressure on emergency departments," Ramsay said in a statement.

"The program supports patient flow across the broader health system and frees up capacity in public emergency departments and hospital wards."

A Sunshine Coast Health spokesperson said, under the program, patients were asked during the triage process if they had private health insurance and if they would like private care.

If so, after consultation, the Ramsay nurse helped facilitate a private hospital transfer.

"This streamlined process, which was introduced in May 2025, allows private patients to be fast-tracked through the transfer process, which was previously managed by Sunshine Coast Health clinicians," they said.

"It has a positive flow-on effect for all patients, as it improves efficiency and flow across our three emergency departments."