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Medical Health Aged Care, Seniors Interest

Doubling demand by 2030: How one program is easing joint replacement woes.

HCF 6 mins read
Janet Novak tickled pink following successful knee replacement surgery with no-gap to pay.

MONDAY, 03 JUNE 2024: HCF, Australia's largest not-for-profit health fund, is partnering with four hospitals across New South Wales and Victoria, to provide patients with affordable, supported solutions, after recent research revealed over 120,000 Australians undergo hip and knee joint replacement surgery every year,1 often encountering long wait times and out-of-pocket costs.

This number is expected to double by 2030, due to an ageing population, longer life expectancy and rising obesity rates.1

“The increase highlights an urgent need for new and creative solutions, especially as healthcare costs continue to rise, and delays in the public health system make elective surgery waits even longer,” said Monash University Professor Ilana Ackerman, who led the study funded by an HCF Research Foundation Innovation Grant.

With a focus on the adoption of short-stay joint replacement care models in Australia, the research aims to make joint surgery more affordable and accessible, with potential savings of up to $641 million across public and private health systems over the next seven years.1

HCF has seen nearly 700 patients go through their ‘No-Gap Joints’ program at four hospitals, saving participating members on average $2,500, and more than $1.6 million in out-of-pocket fees since it launched in April 2021.

One of those patients is Katoomba resident, Janet Novak. Like many Australians, Janet found herself struggling with arthritis and limited mobility eighteen months ago after a fall.

“I realised I needed to do something to get it taken care of because I was experiencing significant pain and finding walking very difficult,” Janet said.

Janet sought medical help, receiving a steroid injection into the injured knee to ease the pain, but the discomfort persisted.

She went back to her doctor multiple times, trying various treatments, including another injection, anti-inflammatories, and physiotherapy, but nothing provided lasting relief.

Eventually, after insisting on an MRI, Janet discovered the extent of her injury – a torn tendon with significant damage. Weight-bearing x-rays revealed it was bone-on-bone, further exacerbating her pain.

Faced with the prospect of substantial out-of-pocket costs, Janet turned to her health fund’s website for alternatives and found the No-Gap Joints program*.

“The program not only covered the full cost of the procedure but also helped with all the associated expenses,” said Janet.

“And I was also able to choose from a long list of good surgeons who could perform the procedure at a few different hospitals.”

Janet noticed that Macquarie University Hospital was participating, a facility she had heard praised by friends.

“I checked my cover to be sure I was eligible for joint replacements and then I got in touch with the surgeon to make sure he was participating in the program, and he was, which was fantastic,” Janet said.

“It was all very organised. The hospital had a good pre-admission clinic and I saw a physio there before I went in, and he organised for me to have physio at home.

“Having rehab at home made recovery so much more convenient and easier,” said Janet.

Maintaining continuity of specialist care in the chosen hospital, from admission to post-rehabilitation, is a core aspect of the No-Gap Joints program, said HCF Chief Officer of Member Health, Julie Andrews.

“This holistic approach helps members feel supported at every step of their journey,” Ms Andrews said.

Janet said, “Another benefit is that I didn’t have to worry about long surgery waitlists. I saw him in February, and I had the operation in March, about a month later.”

Data from the Australian Institute of Health and Welfare reveal that almost one in five (19%) total hip replacement patients and nearly one in three (30%) total knee replacement patients are waiting over a year for surgery in the public health system,2 with even longer wait times recorded within the Nepean Blue Mountains LHN.3

“That can be a long time to wait when you’re in pain. Initiatives like HCF’s program are vital in helping to ease the strain on the public health system and improve patient outcomes,” said Ms Andrews.

“By reducing out-of-pocket costs during and after surgery, and simplifying access to quality healthcare, HCF’s No-Gap Joints program allows members to focus on their recovery,” Ms Andrews said.

Janet agrees, saying the benefits of the program extend far beyond financial savings.

“I’m grateful for the opportunity to reclaim my mobility and independence,” said Janet, who’s already planning a trip with her husband to celebrate their 40th wedding anniversary using the money they saved.

Ms Andrews said, “Janet’s experience serves as a tangible example of the program’s value amid cost-of-living pressures and a backdrop of growing healthcare demands.”

“As healthcare costs continue to escalate and waiting times in the public health system persist, initiatives like HCF's No-Gap Joints program become increasingly essential,” said Walter Kmet, Chief Executive, MQ Health.

“By offering a comprehensive solution that addresses both financial concerns and access to quality care, we are empowering patients to prioritise their health and well-being.

“Macquarie University Hospital is proud to be part of this initiative, offering our world-class orthopaedic unit to ensure patients receive the highest standard of care throughout their joint replacement journey,” Mr Kmet said.

Hospitals where HCF No-Gap Joint is provided:

For more information, visit https://www.hcf.com.au/members/no-gap-services/nogapjoints

ENDS

REFERENCES

  1. HCF Research Foundation Innovation Grant Final Report: Short-stay joint replacement. (March 2023). Chief Investigators: Prof. Ilana Ackerman, Prof. Ian Harris, Conjoint Prof. Justine Naylor, Dr. Peter Lewis, et al.
  2. Australian institute of Health and Welfare. Elective surgery waiting times 2020-21. Available from https://www.aihw.gov.au/reports-data/myhospitals/sectors/elective-surgery; accessed 18.4.24
  3. Nepean Blue Mountains Local Health District & Australian Institute of Health and Welfare. (2022). Total knee replacement: Elective surgery waiting times 2022-23 [Data file]. Retrieved from https://www.aihw.gov.au/reports-data/myhospitals/lhn/lhn105

 

 


Key Facts:

120,000 Australians undergo hip and knee joint replacement surgery each year.

This number is expected to double by 2030, due to an ageing population, longer life expectancy and rising obesity rates.

HCF has seen nearly 700 patients go through their ‘No-Gap’ program at four hospitals.

The program has saved participating members on average $2,500, and more than $1.6 million in out-of-pocket fees since it launched in April 2021.


About us:

ABOUT HCF

HCF, Australia’s largest not-for-profit health fund protecting Australians since 1932, covers almost 2 million members with health and life insurance, and travel and pet insurance. HCF has been awarded Outstanding Value Health Insurance by Canstar eight years in a row from 2016-2023. On average over the last ten years, HCF has paid out more cents in every dollar in premiums to members as benefits than the industry average. To learn more about HCF go to hcf.com.au/about-us

 

ABOUT THE HCF NO-GAP JOINTS PROGRAM

The No-Gap Joints program for primary hip and knee replacements gives eligible members* greater access to high-quality care with no out-of-pocket costs from hospital admission through to discharge and post-surgery rehab, with participating private hospitals and clinicians, so members can focus on their surgery and recovery. HCF has partnered with three Sydney hospitals and one Melbourne hospital*, where members have full control over their choice of specialists, ensuring continuity of care with the same health professionals and hospital coordinating admission and post-surgery care. The program includes participating surgeon costs for primary hip or knee replacement surgery, pathology and radiology while admitted for your surgery, hospital services including accommodation and theatre (excludes any hospital excess members might need to pay), costs related to an anaesthetist and theatre support to assist with surgery and rehabilitation, organised by the participating hospital if clinically required. Eligible members who have held joint replacement cover with HCF for 12 months, are accepted into the program by the participating hospital and clinician and undergo their joint replacement surgery before the relevant proposed trial program end date*, are covered.

* Eligible members will need to have HCF hospital cover including primary hip and knee replacements for 12 months (excluding Overseas Visitors Health Cover). Members will be accepted into the program in line with clinical criteria by the participating clinician and hospital on a patient-by-patient basis. Must be admitted at Macquarie University Hospital, East Sydney Private Hospital, Hurstville Private Hospital or Vermont Private Hospital. You must undergo your joint replacement surgery before the proposed trial program end date. The No-Gaps Joint Program is proposed to end on 30 September 2024 at Macquarie University Hospital, 31 October 2024 at Vermont Private Hospital, and 31 March 2025 at Hurstville Private Hospital and East Sydney Private Hospital.

ABOUT MACQUARIE UNIVERSITY HOSPITAL

Macquarie University Hospital is part of MQ Health. As Australia’s first university-led, fully integrated academic health sciences centre, MQ Health brings together world-class clinical care, education and research. Dedicated to providing exceptional patient care, the hospital offers a wide range of specialised medical services. With state-of-the-art facilities and a team of highly skilled healthcare professionals, the hospital delivers cutting-edge treatments and medical breakthroughs. Notably, Macquarie University Hospital features an extensive robotic surgery program, leveraging advanced technology to enhance surgical precision and patient outcomes. Committed to excellence and compassion, the hospital continues to pioneer advances in healthcare delivery, pushing the boundaries of medical knowledge and practice. By integrating education, research and patient care, Macquarie University Hospital strives to improve health outcomes and enhance the well-being of individuals and communities locally and globally.


Contact details:

Joni Thomes 0475 576 738 or jthomes@hcf.com.au

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