Non-reimbursement for preventable health care-acquired conditions

Christopher Davis
Med J Aust 2016; 204 (3): . || doi: 10.5694/mja15.00952
Published online: 15 February 2016

Managing health care risk must be evidence based and not harm patients or the common good

The decision by Australia’s largest private health insurer Medibank to not reimburse hospitals for 165 hospital-acquired complications that it deems preventable has the stated objective of improving patient care and thereby containing costs.1 As with all health care claims, this requires assessment of potential efficacy as well as possible perverse or harmful outcomes.

  • Private Practice, Brisbane, QLD


Competing interests:

No relevant disclosures.

  • 1. Medibank. Hospital acquired complications, 2015. (accessed Nov 2105).
  • 2. Wachter RM, Foster NE, Dudley RA. Medicare’s decision to withhold payment for hospital errors: the devil is in the details. Jt Comm J Qual Patient Saf 2008; 34: 116-123.
  • 3. Lee GM, Kleinman K, Soumerai SB, et al. Effect of nonpayment for preventable infections in US hospitals. N Engl J Med 2012; 367: 1428-1437.
  • 4. Mookherjee S, Vidyarthi AR, Ranji SR, et al. Potential unintended consequences due to Medicare’s “No Pay for Errors Rule”? J Gen Intern Med 2010; 25: 1097-1101.
  • 5. McDonald R. Paying for performance in healthcare organisations. Int J Health Policy Manag 2014; 2: 59-60.
  • 6. McDonald R. Financial incentives and the governance of performance. In: Kuhlmann E, Blank RH, Bourgeault IL, Wendt C, editors. The Palgrave international handbook of healthcare policy and governance. Basingstoke, UK: Palgrave Macmillan, 2015, pp 393-408.
  • 7. Shabot MM. New tools for high reliability healthcare. BMJ Qual Saf 2015; 24: 423-424.
  • 8. Horstman MJ, Naik AD. A ‘Just Culture’ for performance measures. BMJ Qual Saf 2015; 24: 486-489.
  • 9. Atun R. Transitioning health systems for multimorbidity. Lancet 2015; 386: 721-722.
  • 10. Cheadle WG, Barnett R. Never say never again! The Thirty-third Presidential Address to the Surgical Infection Society. Surg Infect 2014; 15: 145-153.


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