Does Medicare Australia have the power to see patient details now?

No. Until this initiative, the privacy of your patient record has been rigorously protected by law. Currently legislation specifically bans Medicare Australia from requiring doctors to provide clinical details about their patients, except under a warrant issued by a magistrate.

Under subsection 8P(3) of the Medicare Australia Act 1973 the CEO of Medicare Australia cannot:
(a) require information to be given about the contents of a part of a record that is a part containing clinical details relating to a patient; or
(b) require production of a part of a record that contains such clinical details.

Medicare and the Government say this is primarily aimed at administrative information. Is this true?

No. The measure is specifically designed to compel doctors to provide information, which in most cases will only be available from clinical information stored in your patient record.

Your private medical information is specifically protected under present legislation.

Will I be told when Medicare is accessing my patient record, including the details they have seen?

No.  Under this plan Medicare will not be required to tell you that they have asked your doctor to provide information to them that may be specifically about you. According to Medicare this is because it “may cause unnecessary anxiety to some people”.

The present system, which permits access to patient records for criminal proceedings, requires that each patient be notified individually whenever this occurs.

Is the information from the patient record anonymous?

No. The Medicare fact sheet says letters of demand will not identify patients by name. But doctors know patients by name – not by Medicare number so the present practice is that Medicare has to tell the provider your name, having retrieved that information from the linkage to your Medicare number.

Irrespective of what appears on the letter of demand, the Medicare officer will look at your private health details if your doctor has to provide that information in order to verify Medicare payments you have received.

Isn’t it worth it to save $70 million over four years?

The cost of doing the audits is $76.9 million (that’s about $9600 per audit). When you take the cost from the anticipated recoveries the so-called saving works out at $17.5 million a year.

This puts the price of confidentiality of your private health record at about 80 cents per Australian per year.

We are giving away the right to privacy of every patient record for a very low saving of about 80 cents per Australian per year.

And there are no guarantees the scheme will save anything. When the Senate asked for the assumptions under which the savings estimates were made, none were provided. The estimates are a guess based largely around the projected deterrent effect.

Isn’t this just doctors trying to avoid the auditors?

No. Doctors are supportive of reasonable measures designed to protect the system that their patients rely on.  The AMA does not support doctors billing Medicare items for services they did not provide. The AMA encourages the appropriate use of Medicare rebates for patients.

No one likes audits. This measure increases the incidence of audits fivefold. The extraordinary increase is based on a guess that thousands of providers are cheating the system, even though Medicare agrees that the vast majority of doctors are honest, and that most problems are attributable to honest mistakes and an increasingly complex system rather than dishonesty.  

The AMA is not objecting to the increase in audits. Our key objection to this major impost is that it compels doctors to provide details that destroy patient trust and will legally oblige us to dishonour our oath to keep your health information private.

Doctors support compliance activity as a necessary measure to preserve the integrity of the system. We are ready to work with auditors to provide reasonable information to satisfy their needs.

Medicare has an excellent privacy record – why shouldn’t they be trusted with my health details?

The first consideration is that it is unnecessary for Medicare to have these powers and be able to enter into your personal medical notes.

Recognition of the excellent privacy record of the processes inside Medicare does not provide comfort to the threshold issue of Medicare being able to read, copy and/or take extracts directly from the individual health record.

It legitimises a new invasion of personal and private information and this is the issue that the public will need to know about and understand.

We believe inviting Medicare into the consultation room will impact on the capacity for patients to tell us everything we need to know. For many people the doctor is the only person in the world with whom they share all of their personal life, health and family concerns.  For many it’s just too embarrassing or hurtful to relate details outside of the absolute confidence of the doctor’s surgery. Other patients simply object to the Government legislating away another basic right which is currently protected by legislation.

Selling out patient confidentiality also puts doctors in a tough position. Like most professionals, we take our oath very seriously. Some doctors are already saying they will go to jail rather than hand over patient records.

How will the new system work?

The new system will cost $76.9 million. Under the proposed legislation providers will receive a letter demanding they produce doucments to justify the billing of a Medicare item number, or numbers.

Doctors will be compelled to choose between maintaing patient privacy and paying a fine even though they have done nothing wrong, or releasing patient information in order to prove they have done nothing wrong.

It may be that if this legislation passes, patients who can afford to see their doctor without accepting a Medicare rebate will have the right to privacy in Australia because their patient record would be unable to be invaded by Medicare, while other Australians who rely on the Medicare rebate will have had their right to privacy taken away from them by Government.

The alternative would be for doctors not to use the Medicare rebate item numbers when billing patients, but actually just describe the service, forcing Medicare to work out the rebate that the patient should receive. Doctors do not do this now because this would delay rebates for patients.

Do people really care?

Some people don’t worry too much about the privacy of their health details. Perhaps they have different sensitivities about what is in their record, or they do not feel that there is anything there they need or wish to protect about themselves or others.

For others though, privacy is precious, and the certainty of the confidentiality of their discussion is the key understanding and basis for the consultation with their doctor.

Doctors believe that undermining the security of that confidentiality is:

• dangerous for patients, as it discourages those who are concerned for their privacy from a frank exchange with their doctor; and,
• unnecessary as there is no evidence of the high level abuse of the system, which warrants a five fold increase in audits and a $76.9 million investment.. Medicare itself admits the vast majority of problem claims are the result of honest mistakes and a complex system.

Doctors will work with Medicare to ensure the integrity of the system. There is no need, and real danger, in selling out patient privacy to achieve this.