On 20 March 2020, one week after the World Health Organization (WHO) labelled the coronavirus a global pandemic, Australia closed its borders to all non-residents of the country, allowing permanent resident holders entry to the country on condition of a 14-day home quarantine upon arrival. The country also shut down many of its internal states and borders. Following this, Australia, much like the rest of the world, drastically reduced the provision of elective surgeries across both the public and private healthcare facilities in order to deal with an influx of hospitalised Covid-19 patients. In line with social distancing guidelines, the country also facilitated a shift towards remote, virtual care services among health insurers, private hospitals and the public sector.
In all, Australia’s response was among the most successful for controlling and curtailing the spread of Covid-19, and many have commended it as such. However, it hasn’t been without controversy – as Inez Cooper, Managing Director and Co-Founder of expat international private medical insurance provider William Russell, notes, there are currently an estimated 35,000 Australians still stranded overseas, unable to return to the country due to the rigid border controls in place. What’s more, professionals are growing increasingly concerned that there will be a lack of herd immunity due to low virus exposure. Add to this the country’s low vaccination rates, and it’s easy to see how it’s at heightened risk of outbreaks once borders do eventually reopen.
How expat healthcare works in Oz
A Department for Health spokesperson explained that Australia has Reciprocal Health Care Agreements with 11 other countries which cover essential and immediately necessary medical treatment, depending on the respective arrangements under each agreement.
“Partner countries include Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, the Republic of Ireland, Slovenia, Sweden and the United Kingdom,” he said. “The Reciprocal Health Care Agreements do not cover treatment as a private patient in a public or private hospital or people visiting Australia for the specific purpose of receiving treatment.”
In the absence of Medicare eligibility, all visitors to Australia are strongly recommended to make their own arrangements for private health insurance to ensure they are fully covered for any unplanned medical or hospital care they may need while in the country.
For the international assistance industry, operations in Australia haven’t exactly been effortless this year. Anna Gladman, CEO of Australian travel insurance and assistance provider nib Travel, tells Hospitals & Healthcare that individuals providing critical or specialist medical services (such as air ambulances, medical evacuations and those delivering critical medical supplies) have had the ability to apply for an exemption into Australia. However, the Australian Government’s ’risk-averse approach’ to border protection in response to the Covid-19 pandemic has led to limited entry points into the country, along with a significant reduction in flights in and out of Australia.
“It’s already hard enough to extract people with life-threatening conditions from remote regions to a major urban hub,” Cooper added, commenting on medical evacuations, which she says have been the ’most affected area of expat assistance’. “Travel disruption and government restrictions have made this almost impossible.” Cooper also believes that the strict border closures will have had an adverse effect on the mental wellbeing of globally mobile individuals unable to re-enter Australia. “With the borders in Australia and New Zealand not to be open any time soon, we suspect a lot of mental health challenges [are] going on. According to our survey of over 1,000 expats around the world, 38 per cent have confirmed their mental health has been down since the beginning of the pandemic more than a year ago, and nearly half of expats wanted to return to their home country during Covid-19.” Furthermore, Cooper also noted that 36 per cent of Australian expats said that they have been ’sceptical’ or ’unsatisfied’ with the professional mental health support in their country of residence.
Elective surgery on the backburner
On the ground, healthcare provision in Australia has changed a lot too. Gladman says that there was a ’quick and unified pandemic response’ for healthcare in Australia implemented by the Australian Commission on Safety and Quality in Healthcare. She added: “Additional resources and advice on how to reduce the risk of coronavirus exposure and infection in response to the pandemic were issued for Australian health service organisations and healthcare professionals pertaining to personal protective equipment, infection prevention and control risk management, environmental cleaning, hand hygiene, medicines management, wearing facemasks in the community, cognitive impairment care and elective surgery.”
Specifically with regards to elective surgery, Gladman explains that in the first half of 2020, ’when Covid-19 in Australia was at its worst’, these treatments were reduced to a minimum, both in the public and private sector. Cooper insists that this situation caused friction among private healthcare providers. “In general, the private sector has helped with the public health effort, but there were some moments of controversy,” she explained. “Australia – unlike many countries in Europe and North America – banned elective surgery, which led to a standoff between private hospitals and the government. The private hospitals even threatened to close their doors unless their revenue was replaced by the government.”
Of course, as Gladman notes, special funding was given to private hospitals in preparation for a shortage of beds in the public system. However, both Gladman and Cooper identify that the need for those lost elective treatments hasn’t dissipated. Rather, reduced access to these services has created a backlog of treatments and surgeries that still need to be scheduled (and this is true elsewhere in the world too). Gladman notes that nib Travel is provisioning for a ’claims catch-up’ of treatment for its health insurance members.
To give Australia its dues, the country’s response was in many ways one of the most successful – evidenced by the fact that it began enjoying a reciprocal travel bubble with New Zealand long before many countries were able to consider reopening their borders. And it would be impossible to scrutinise any country’s response to the global pandemic and find that there were not lessons to be learned somewhere down the line. Indeed, Robin Ingle, Chairman of Travel Navigator, CEO of Novus Health and Ingle International is quick to highlight that issues with healthcare provision and medical assistance – including increased rules and regulations for assistance services and air evacuations, increased liability issues for both staff, policyholders and patients, and postponed elective treatments – have been similar around the globe.
How Australia plans to safeguard against Covid-19 going forward is another thing altogether though – and will be key to ensuring the health and safety of its abundant visitors, especially as Cooper projects another worrying premonition. She reasons that while only around 900 people have died in Australia after catching Covid-19 (compared with nearly 128,000 in the UK), ’and infection rates are virtually zero’, the country could find itself increasingly vulnerable to overseas infections once it does reopen on a larger scale. She told Hospitals & Healthcare: “Doctors fear that Australia, like New Zealand, will find it difficult to reopen after keeping the virus out, because a lack of herd immunity and the slow vaccine rollout will make it vulnerable to infections brought in from overseas.”
More worrying still is the recent revelation that Australians are overwhelmingly hesitant about getting vaccinated – research by the Australian National University (ANU) revealed that eight in 10 Australians (out of the study’s 3,000 participants) were worried about possible side effects of the vaccine, and that half of the people that said that they definitely wouldn’t take a vaccine, noted that their decision was based on recent news about the AstraZeneca vaccine and blood clotting. A separate survey commissioned by the Sydney Morning Herald revealed that 21 per cent of its respondents felt a lack of urgency to get immunised while Australia’s borders remain shut.
Safeguarding traveller health in 2021 and beyond
Ingle mused that the restrictive stance of governments like those in New Zealand and Australia were unlikely to ease up much as ’we roll through another few years of varying infection rates and variants’. He told Hospitals & Healthcare that it was important for the industry to understand that ’the pandemic is not over’.
“We need to be aware that this will continue for a few years and that other pandemics can occur,” he said.
Further to that, he warns that a disparity in vaccine access will not only affect tourism in the region and beyond, it will also make assistance more complex. He added: “Assistance companies need to verify the capability of healthcare providers, their ability to accept patients, the backup plans (in case there is an increased infection rate) and that the healthcare provider is repurposed by the local or national governments.
Gladman says that thanks to Australia’s Covid-19 strategy, as well as the reassuring fact that all hospitals must be accredited against the National Safety and Quality Health Service (NSQHS) standards as part of the Australian Health Service Safety and Quality Accreditation (AHSSQA) scheme, the country’s local hospital system should be able to manage both the local population and any travellers should they require assistance – even if Covid-19 numbers in the country increase.
And while Australian public policy think tank the Grattan Institute may have asserted that Australia’s private health insurance industry is set for a ’death spiral’, Cooper paints a more promising picture for the IPMI industry. She says that despite both the value and volume of William Russell’s claims being ’well down’ over the past 12 months, the firm has experienced a huge increase in its life insurance policies for expats in this time period, and visitors to the website for life insurance in April 2021 are up 72 per cent compared to last year. “In our view, provision of healthcare has strengthened. It highlights the importance of private healthcare, particularly international plans. We cannot say with confidence what will happen to premiums, but we expect these will continue to rise for a number of months before stabilising as insurers clear the effects of any post-pandemic bounce in claim volume,” she said.
Let the travel assistance industry help reconnect global destinations
The outcome of Australia’s strict border measures will continue to be seen in the coming months and, as many (including the country’s own government) predict, international travel with the rest of the world is likely to remain off the menu at least until the end of the year.
Key issues surrounding vaccine distribution among the Australian population will continue to be front of mind for those looking at the long-term prospects of the country’s international travel industry, especially as its travel bubble partner New Zealand finds itself in a worryingly similar quandary, having fully vaccinated no more than four per cent of its own population at the time of writing.
While the exclusive trans-Tasman bubble allows both countries to largely avoid the chaos of new Covid cases, new variants, and surging hospitalisations that the rest of the world finds itself increasingly accustomed to, the restrictive travel protocols require international medical assistance providers operating in the region to expend increased time and resources – key components that should not be stretched when it comes to international patient assistance.
Let’s put it this way: the mere existence of the travel insurance and assistance industry proves that risk is inevitable. And the success and continued growth of this multi-billion-dollar global industry highlights that it’s far better to conquer risk by managing and controlling it rather than attempting to avoid it entirely (or else no one would ever travel anywhere) – especially going into a future where, as Ingle points out, the occurrence of other pandemics is looking increasingly likely.
Thanks to travel and health now being synonymous, the importance of healthcare provision across the world has come under the global spotlight. Travel insurers and assistance providers have long been investigating and improving the efficiency of healthcare accessibility for international travellers and, as the rest of the world also begins to understand the crucial role that high-quality healthcare facilities, regulation and accreditation, and travel and health insurance protection play in the travel sphere, as well as how these factors can also help support the tourism and medical travel revenue of worldwide destinations, we shall surely also see some harmony in the reopening of borders around the world, including Australia.