Our performance-based model

Hospital acquired complications

Hospital acquired complications are complications acquired while a patient is admitted to hospital or as a result of treatment received while the patient is in hospital.

While complications can occur, evidence shows that their frequency can be reduced if clinical guidelines are followed.

Medibank is working with hospitals, doctors and other partners across the private healthcare system to implement important changes aimed at reducing the frequency of hospital acquired complications and patient readmissions.

Our value based contracts

Medibank’s new value based contracts with many private hospitals seek to encourage quality, safety and improved efficiencies by hospitals in the interests of our members and their patients, and recognise hospitals for achieving a higher standard of care.

Hospital acquired complications can have an adverse impact on the health of patients and may necessitate additional treatments, which can not only increase risks to the patient but can also be costly.

Medibank wants to encourage hospitals to adopt best practice and ensure they have robust measures in place to reduce the frequency of complications as much as possible.

To encourage hospitals to have robust patient care practices in place, Medibank has developed a list of hospital acquired complications which it may expect the hospital to fund unless the hospital can demonstrate that they undertook steps to reduce the risk of the complication occurring.

Based on the list of hospital acquired complications published by the Australian Commission on Quality and Safety in Health Care, Medibank has developed a subset of 82 hospital acquired complications which Medibank considers:

  • are more likely to occur in an acute private hospital setting
  • are likely to occur more frequently and to be more significant, based on Medibank’s claims history; and
  • have good evidence to show that their frequency can be reduced if clinical guidelines are followed.

These include, for example, pressure injuries, falls, healthcare associated infections, surgical complications and blood clots.

Medibank will require the hospitals to demonstrate that they have taken these hospital acquired complications seriously and followed local Clinical Practice Guidelines or industry accepted guidelines, or that the complication was not due to treatment either provided or withheld during the admission, otherwise the hospitals will be expected to fund the costs associated with treating the complication.

This approach is based on a thorough review of Australian and international evidence and has been refined in discussions with our hospital partners over the last 18 months.

Currently, Medibank has value based contracts in place with more than 120 hospitals, representing around 70 per cent of Australia’s major private hospitals.

Early indications suggest improvements are already being made and are benefiting our members.

We are confident our value based contracts will further strengthen the already high standard of healthcare our hospital partners provide.

Please see Medibank’s fact sheet for further information.

What do these changes mean for our members?

The treatment a member is covered for will not change. Medibank will still pay benefits towards the costs of the original treatment on behalf of members, in line with the terms of their policy.

Members will not be faced with additional charges as a result of these changes, and they will continue to have access to high quality treatment in their hospital of choice.

Will the changes affect payments to doctors?

Medibank’s payments to medical specialists for our members’ care, including the surgeon, physician, anaesthetist and assistant surgeon, remain unchanged. This is purely an arrangement between Medibank and participating hospitals.

Who can I speak to for more information?

For contracted hospitals, please speak to your Medibank Contract Manager in the first instance.

For all other stakeholders, please contact icreview@medibank.com.au