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:
- East Sydney Private Hospital, NSW
- Hurstville Private Hospital, NSW
- Macquarie University Hospital, NSW
- Vermont Private Hospital, Vic
