EXCLUSIVE

Sam Taylor's children were just 6 and 14 when she was asked to make a choice no woman ever wants to make.

Diagnosed with an aggressive form of breast cancer in May last year, Taylor tested positive for the BRCA1 gene mutation that greatly increases the lifetime risk of developing cancer.

Doctors said she had two options: wait up to three years in the public system for the double mastectomy that might save her life or spend thousands of dollars going through private insurance.

No time to lose: Sam Taylor (pictured with her daughter Jade) decided to go through private insurance for after being told she could wait up to three years to have a double mastectomy in the public system.

No time to lose: Sam Taylor (pictured with her daughter Jade) decided to go through private insurance for after being told she could wait up to three years to have a double mastectomy in the public system. Photo: Ben Rushton

After six months of chemotherapy and with a husband and two young children to consider, it was "a no-brainer", Taylor says. "You're told it could be back within five [years]; I don't have three years to wait."

The 41-year-old had a double mastectomy and breast reconstruction in February. The procedure, free under Medicare, cost nearly $15,000. Private insurance covered less than $3600 but there was no wait, Taylor says.

"We're selling our house at the end of the year because the bills are just piling up ... I'm really lucky my husband has a great job and we had extra equity in the house," she said.

"If Scott and I had this diagnosis 20 years ago I would have been on the waiting list. I would have had no option."

It's an option an increasing number of Australians probably wish they had.

Private insurance, public resources

Hospital waiting times are growing longer because Australia's "two-tier" health system is pushing resources from the public to the private system, experts say.

Nearly 90 per cent of private health insurance coverage here duplicates public services, meaning private patients get the same treatment but faster access, an international analysis has shown.

Health economists say waiting times for people without private insurance will worsen if nothing is done to address the large overlap between the public and private systems, and suggest the private system should instead be harnessed to help those most in need of care.

Duplication was intended to cut queues in the public health sector by creating a parallel system for wealthier Australians with private health cover. But instead it has led to doctors abandoning the public system for the better-resourced private market, and given private patients priority access to public facilities.

This is lengthening waiting times in the public sector despite private insurance reducing the number of people queuing, according to Jim Gillespie, deputy director of the Menzies Centre for Health Policy at the University of Sydney.

"It's certainly not reducing the queues in the way the original justification set out," he said.

In co-located hospitals, for example, "private health insurance is really just paying for you to jump the queue and … use exactly the same surgical team that the public sector is using. You'll even get wheeled on the bridge from the private hospital to the public hospital for the operation."

Meanwhile, in areas such as ophthalmology, orthopaedic surgery and ear, nose and throat surgery, duplication has shifted the workforce largely to the private sector. "Providers can make a lot more money offering [medical services] in the private sector than in the public, so quite a few of those 'duplicate' procedures are often difficult to get in the public sector anymore."

From 2008 to 2012, median waiting times for public elective surgery worsened from 33 to 36 days, and the time taken to treat 90 per cent of patients rose from 219 to 265 days, according to the Australian Institute of Health and Welfare.

More than half of all Australians have private health insurance, 86 per cent of which is duplicate, according to a report by the OECD. Australia has the second-largest duplicate insurance market of the 24 advanced economies included in the analysis.

A tale of two systems and one public purse

Jeff Richardson, foundation director of the Centre for Health Economics at Monash University, says duplication has created two medical systems, both funded primarily through the public purse.

"We run a two-tier health system now. There's no point in calling it other than that," he said.

"Both systems offer a number of similar services for the same complaint … [But] private health funds are not funding medicine, by and large. They're simply giving people access to private hospitals."

Only 10 per cent of money paid by private insurers is spent on medical services, according to 2013 AIHW figures.

Private Healthcare Australia CEO Michael Armitage says insurers are hamstrung by government regulations barring them from certain areas of the health sector. "But in the areas in which we are allowed to operate, we are the big player."

He cites hospital statistics for same-day specialist mental health treatments and cancer therapy that show private hospitals treat the bulk of these patients. "If they were not privately insured ... all of that burden would then fall on the public health sector."

Associate Professor Gillespie says one way forward would be to regulate private insurance in a way that reduces duplication in future. "For example, give it incentives to look after people with chronic illness," he said.

But a spokesman for Federal Health Minister Peter Dutton says it's illogical to suggest duplication is a problem. "The private system takes pressure off public hospitals and emergency departments," he said.

Former federal health minister, Michael Wooldridge, who oversaw efforts to boost private insurance membership under the Howard government, says opposition to the model is "nothing more than ... ideological".

"I see [duplication] as being a fundamental part of one of the most successful health systems in the world," he said.