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10 Oct 2017

BY DR CHRIS MOY, CHAIR, AMA ETHICS AND MEDICO LEGAL COMMITTEE

In September, the AMA gave evidence at the Parliamentary Joint Committee on Corporations and Financial Services’ Inquiry into the Life Insurance Industry. The AMA, along with representatives from the Australian Health Practitioner Regulation Agency (AHPRA), the Medical Board of Australia (MBA) and the Royal Australian College of General Practitioners (RACGP) (herein ‘the participants’) responded to a range of questions on the interaction between doctors and the life insurance industry. Questions primarily focused on the disclosure of patient information including medical records and the implications of life insurer requests for genetic test results. Prior to the public hearing, the AMA responded to the Committee’s Questions on Notice in relation to independent medical examiners.

During the hearing, the participants raised specific concerns regarding inappropriate requests by insurance companies for doctors to hand over full patient medical records. Such a request places the doctor in a difficult position as the range of content in a patient’s medical record may not be relevant to the insurance claim, may include sensitive information or may include the doctor’s personal notes or ‘aide-memoirs’.

In such circumstances, the doctor must decide whether to simply comply with the request for the full medical record or try to contact the patient to discuss what information, if any, the patient is willing to disclose and in what format. While this may be ‘ideal’ practice, doctors, particularly GPs, are often time poor and may not be remunerated for such discussions. It was also brought to the Committee’s attention that a patient’s medical records may contain sensitive information about their family members as well.

The participants emphasised the real risk that patients may not fully disclose their medical history, or may forego attending a doctor altogether, for fear such information may adversely affect their insurance premiums or claims.  

The participants agreed that the regulations relevant to life insurers’ requests for patient information should be tightened so that insurers are only allowed to request specific, targeted information and not make blanket requests for patients’ full medical records. In addition, the patient’s consent to disclose their personal health information to an insurer should be recent and relevant to the issue at hand (eg. not the broad, generalised consent to release personal information that everyone gives when applying for insurance cover).

The participants agreed there should be greater public education for consumers regarding consent and disclosure of personal health information to life insurers. Further, doctors should be appropriately remunerated for having relevant consent discussions with patients.

Specific concerns were raised in relation to disclosing a patient’s genetic test results to their insurer. Currently, a person applying for life insurance must disclose to the insurer any medical information, including the results of genetic tests, known to them that might impact on their application. The AMA highlighted that many genetic tests are predictive in nature and the results do not necessarily guarantee a person will develop the condition that is being tested.

Genetic tests that provide information on the risk of developing a particular condition can be extremely beneficial to a person’s health care (and that of their biological family members as well) – allowing them to take greater advantage of preventive health measures, screening and lifestyle modifications. Doctors do not want patients deterred from undertaking such testing due to fears it may affect their life insurance premiums.

Although not specifically relevant to the Inquiry, the AMA advocated that doctors, in particular GPs, need more education and training in relation to providing genetic counselling, interpreting genetic test results and assessing the accuracy and validity of direct-to-consumer genetic tests (eg. those a consumer can buy online or at the chemist).

The committee is currently due to report on December 7.

 


Published: 10 Oct 2017