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27 Jun 2017

By Associate Professor Julian Rait, Chair, Council of Private Specialist Practice

The Council of Private Specialist Practice (CPSP) met at Melbourne Airport on June 10 for its first face-to-face meeting since the Council’s inception in 2016. This offered the opportunity to discuss a range of pressing issues and policy changes, as well as prepare for a series of forthcoming inquiries and reviews.

Many members would be aware that there are a number of specific health initiatives underway – each of which will have varying degrees of impact for private practitioners. In that light, CPSP members have discussed a number of recent developments to inform the Federal AMA’s advocacy strategy.

In particular, there is no doubt that the media, and by extension the broader population, have been questioning the value and affordability of private health insurance. Government, industry, hospitals and the medical profession are all looking for improvement in the value proposition. And of course, all have different perspectives on how this might be achieved.

Notwithstanding the AMA’s stated support for many of these health reforms, CPSP’s discussion centred on initiatives to directly assist private practitioners to maintain a more balanced and sustainable health system.

This started by considering AMA’s ongoing contribution to the private health insurance product redesign, which is currently under consideration by the Government-led Private Health Ministerial Advisory Committee (PHMAC). 

While PHMAC conversations have largely been conducted in confidence, it is widely acknowledged that substantial problems exist with the current PHI products. So the development of PHI policies that offer more comprehensive coverage, with clear clinical definitions, and fewer exclusions and carve outs would likely restore the public’s faith in private health insurance. CPSP was able to propose a number of examples that could contribute to the PHMAC process, via the President, as Government considers a more enduring solution.

Another emerging risk is the increased focus of public hospitals on private patient revenue. Unfortunately there have been a number of media reports and an AIHW report that indicate that private patients in public hospitals are being prioritised. Unfortunately this appears to have produced shorter wait times for elective surgeries for privately insured patients when compared to public patients of public hospitals.

However, it is clear in discussion that controlling this situation is a more complicated task than it would appear in media reports. Consequently CPSP resolved to work with the relevant committees within the AMA to further discuss the detail of any new policy initiatives. In particular, CPSP acknowledged that the rights of private practice within the public hospital system are a well-established part of the remuneration of staff specialists. Furthermore, public hospitals, much like the private system, require a more sustainable funding stream. We believe that both sectors need to be well funded in order to have a sustainable health system. Consequently, any future COAG funding agreement for public hospitals needs to be linked to PHI product design – particularly noting the greater uptake of public hospital only insurance policies.

Also looming on the horizon is the upcoming Senate inquiry into the value of private health insurance and out-of-pocket costs. Therefore, CPSP took the opportunity to review and strengthen the AMA’s suite of policies relating to appropriate billing practices, and to reinforce the view that our profession endeavours to be fully compliant with informed financial consent for our patients.

In considering the Senate inquiry, it has also been an opportunity to emphasise the role of the AMA Fees List and how this supports our members to decide on their fees in daily practice, and counter certain media case studies reporting on patients who have suffered significant ‘bill shock’.

And while the AMA does not, and cannot support the charging of excessive fees, it was recognised that the complicated nature of PHI policies and the increasingly complex nature of the MBS schedule all contribute to these billing problems.  However, we also appreciate the potential risks of single billing and the potential of managed care – solutions that unfortunately are likely to be floated during the forthcoming policy debate. 

Finally, proposed reforms of the medical indemnity support schemes will likely cause concern for our members. Many, if not most, doctors will sadly remember the indemnity crisis of 2002 – and no one wants to return to such an era of escalating indemnity premiums and uncertain policy cover. While the MYEFO reductions to some of the indemnity schemes have caused some uncertainty, the forthcoming full review of these indemnity schemes has the potential to cause even more concern as to the future of private specialist practice in Australia.

The AMA has been lobbying extensively and, even though the terms of reference for the review have not been released, we have been reassured that the review will not simply be a ‘cost saving’ exercise. Despite that, CPSP took the opportunity to discuss potential reforms to the indemnity schemes, including those surrounding universal cover, as part of our advance preparation for the development of a comprehensive AMA response.

Therefore it appears that it will continue to be a busy year for health policy debates and for the AMA’s continuing advocacy to improve the security of private practitioners. And if you have views on indemnity, on private health insurance, or on medical fees and out-of-pocket costs that you would like to see raised by CPSP, then please feel free to email Miss Eliisa Fok at the AMA secretariat as follows that the CPSP can consider such additional items.

Published: 27 Jun 2017