Bringing ward experience into the hospital contract
Australian private hospitals usually leave insurer negotiations to commercial and finance teams. The clauses decide staffing, length of stay and discharge planning, so the people who run wards and theatres should help write them.
In most private hospital groups I know, the agreement with a health insurer is negotiated by a commercial director and a finance team, signed by the chief executive and then delivered to operations rather as weather is delivered to farmers. A nurse unit manager learns the result when her staffing budget arrives. A theatre manager learns it when a procedure is moved to a bundled price. Nobody intends this division of labour to cause harm, and the people who negotiate are usually skilled. I have come to think it is still a mistake, because the contract is not a financial document that happens to affect operations. It is the operating plan, written in a different vocabulary.
A hospital keeps three promises at once, to the patient on the list, the doctor who brought her and the fund that pays, and operations is the craft of keeping them in that order when they collide.
Private hospitals still allocate operating sessions to surgeons for decades, used or not. Empty sessions cost patients time they never see on a report, and fair release rules can fix that without driving good surgeons away.
Regional private hospitals often try to offer everything a city hospital does. Low volumes make that unsafe and expensive. A narrower service, designed with the public hospital next door, serves the town better.
Revenue, year to June 2026
A$1.18bn
Twelve private hospitals and four day-surgery centres
Booked theatre time used, 2025
81%
Up from 66 per cent in 2022 across 68 theatres
Agency share of nursing hours, 2025–26
3.8%
Down from 11.6 per cent in 2022
A private hospital's operating plan is largely written in its insurer contracts, so the people who run its wards and theatres should help write them.
I am chief operating officer of Kelvarra Health, a fictional not-for-profit group of twelve private hospitals and four day-surgery centres across south-east and central Queensland and northern New South Wales. We admitted about 196,000 patients in 2025–26 and earned revenue of A$1.18 billion: roughly 70 per cent from private health insurers, 13 per cent from state governments buying care for public patients and 7 per cent from the Commonwealth for veterans. Our surplus stays in the hospitals. Last year it was A$24 million, about two cents in every dollar we received.
My route here began behind an X-ray tube. I trained as a radiographer, managed a regional imaging department, spent five years responsible for eleven small rural hospitals in central Queensland, ran operations for a private imaging network and managed Kelvarra's largest hospital through the first year of the pandemic. I became COO in March 2021. I have worked on both sides of the line between public and private care, and that has turned out to be the most useful thing I know.
Running hospitals for a living has taught me that our three obligations, to the patient on the list, to the specialist who brings that patient to us and to the fund or government that pays, conflict more often than any annual report admits. In 2023 I recommended that we let the contract with our largest insurer lapse rather than accept indexation that would have cut nursing hours by stealth. We spent forty-one days out of contract. I would make the same call again, though I would handle the surgeons and the patients quite differently.
Theatre time returned to the patients waiting
Booked-session utilisation across our 68 theatres rose from 66 to 81 per cent between 2022 and 2025 after we introduced release rules for sessions surgeons did not use. Same-day cancellations fell from 5.8 to 2.7 per cent, and 41 sessions a week moved to surgeons with genuine waiting lists.
An insurer agreement priced on what care costs
After forty-one days out of contract with Wyralee Health Fund in 2023, we signed a three-year agreement indexed at 3.4, 3.6 and 3.5 per cent, against an opening offer of 1.9 per cent a year, and replaced a readmission penalty with a jointly run clinical review.
A regional hospital that pays its way again
Ending private births at Kelvarra Rockhampton and transferring them, with thirteen of our midwives, to the public maternity unit let us take on 2,100 public elective procedures a year. The hospital moved from a loss of A$3.9 million in 2021–22 to a surplus of A$1.4 million in 2024–25.
Agency nursing brought back inside the payroll
Agency hours fell from 11.6 per cent of all nursing hours in 2022 to 3.8 per cent in 2025–26, after we built a relief pool of 140 employed nurses shared between our regional hospitals. The change saves about A$19 million a year and has made ward teams more stable.
Current focus
I am preparing two papers for the board. The first proposes a hospital-in-the-home service for selected medical and orthopaedic patients in Brisbane, which only works if insurers will fund care delivered outside our walls. The second sets out our position for next year's negotiation with our second-largest insurer, where bundled payment for joint replacement will be the main argument.
Conversations I welcome
Kelvarra remains my executive home, and I am not seeking to change that. I would accept one further non-executive directorship, beside my community-transport board, at a health or care organisation that neither competes with Kelvarra nor pays it, ideally joining its quality and safety committee and its audit and risk committee. Twenty-five days a year is what I could commit, once Kelvarra's board has agreed. I accept a few speaking invitations each year on hospital operations and insurer contracting.
Beyond the page
The record behind the perspective.
In the boardroom
Tarrabool Community Transport LimitedNon-executive director; member of the finance, audit and risk committee · 2019–present
Formation
Bachelor of Applied Science (Medical Imaging Technology)Corbridge Hill Institute of Technology · 1993
Master of Health Administration, part-timeEllersby University · 2009
Company directors' courseMarwood Directors' Institute · 2022
Imogen tells the board what a commercial decision will do on a ward before we make it. When the Wyralee offer came, her paper set out the nursing hours at stake, the patients she proposed to protect and what it would cost us. Several of us wanted to sign. She persuaded us with arithmetic, not volume.
Felicity MayberryFictional chair of the board, Kelvarra Health LimitedThe full record ↗
Contact
Kelvarra remains my executive home, and I am not seeking to change that. I would accept one further non-executive directorship, beside my community-transport board, at a health or care organisation that neither competes with Kelvarra nor pays it, ideally joining its quality and safety committee and its audit and risk committee. Twenty-five days a year is what I could commit, once Kelvarra's board has agreed. I accept a few speaking invitations each year on hospital operations and insurer contracting.