Private health reform and new independent authority proposed by AMA

The AMA hosted a Private Health Summit in Canberra calling for improved regulation to deliver better outcomes for patients, private hospitals, insurers, medical device manufacturers and doctors.

Private health sector reform and a new independent body are required to ensure the sustainability of the private health sector and patient access to the care they need, the AMA’s Private Health Summit was told on Thursday.

The summit, held at Parliament House in Canberra on Thursday was attended by about 100 guests. They included the Minister for Health and Aged Care, Mark Butler; the Shadow Minister for Health and Aged Care, Senator Anne Ruston; insurers; hospitals; government representatives; peak bodies from the medical and insurance sector; and consumer representatives.

An AMA discussion paper A whole of system approach to reforming private healthcare  was released and proposes a new body — the Private Health System Authority — to bring the sector together and build consensus on reforms.

AMA President, Dr Omar Khorshid, said the private health system is an essential pillar of the health system, providing almost 60 per cent of elective surgery admissions.

“The system is critical to charting a course out of the COVID-19 pandemic and tackling the growing waiting lists for elective, but essential, surgery,” Dr Khorshid said.

“Without immediate intervention reform will continue to be piecemeal and limited at best, with the real risk of ongoing conflict in the sector, all of which does nothing to instil confidence in policy holders and patients.

"The private health system before COVID saw falling membership and the AMA is concerned memberships will start declining again. There are increasing numbers of older, sicker members, fewer young policyholders and premium rises that are pricing families and young Australians out of the market,” Dr Khorshid said.

“A new Private Health System Authority would help ensure a cohesive regulatory model by relieving the Department of Health of its conflicted role as a regulator and policy maker and it would incorporate new functions to fill gaps in the current regulatory environment.

“Under current arrangements no one has looked at the bigger regulatory picture to gauge the impact of ad hoc changes or balance the interests and needs of patients, day hospitals, private hospitals, private health insurers, medical device manufacturers and doctors.

“We have all said we are not trying to benefit at the expense of others, and all we want is patient-centric, clinician-led care that is safe, high-quality, and delivers value for the patient. We all agree on this, so now is the time to act.

“The authority would create a platform for everyone in the sector to move away from combative debates and work together under better regulation to deliver better outcomes for all. The AMA stands ready to support the sector to safeguard this essential pillar in our healthcare system,” Dr Khorshid said.

Submissions on the discussion paper can be made until 31 August 2022.