Doctor backlash over Defence Force contracts
A backlash from specialists has thrown the takeover of Australian Defence Force health services by a Medibank Private subsidiary into crisis, with less than 10 per cent of practitioners signing up to controversial provider agreements. The early results of a poll of members currently being conducted by the AMA indicates less than one in 10 specialists treating Defence personnel have accepted the terms of preferred provider arrangements set by Medibank Health Solutions (MHS), which earlier this year won a $1.3 billion contract to provide health care services to Defence Force personnel over the next four years.
A backlash from specialists has thrown the takeover of Australian Defence Force health services by a Medibank Private subsidiary into crisis, with less than 10 per cent of practitioners signing up to controversial provider agreements.
The early results of a poll of members currently being conducted by the AMA indicates less than one in 10 specialists treating Defence personnel have accepted the terms of preferred provider arrangements set by Medibank Health Solutions (MHS), which earlier this year won a $1.3 billion contract to provide health care services to Defence Force personnel over the next four years.
AMA President Dr Steve Hambleton has warned the Federal Government that the health care of Defence personnel is being put in jeopardy by the new arrangements and should be abandoned.
“The ADF has given a clear commitment to defence personnel that they will receive high quality health services in a timely fashion,” Dr Hambleton said in a letter to the Minister for Defence Science and Personnel, Warren Snowdon. “On the evidence available, the new arrangements being implemented will not sustain this commitment, and access to health services for our valued serving personnel will be compromised.
“I would urge you to abandon these changes before it is too late and direct the ADF and MHS to work with the profession to develop more sustainable arrangements.”
The AMA has been deluged with complaints from doctors about the terms of the MHS offer.
One doctor, who has provided orthopaedic services to Defence personnel for 14 years, told the AMA that he would “never consider entering into such a flawed and dictatorial contract”, while an anaesthetist said he and four specialist colleagues would not accept the MHS under its current terms.
Another member accused MHS of attempting to introduce managed care “by stealth”, while a former Regular Army Medical Officer lamented that a mass withdrawal by specialists from treating Defence personnel may be the only way to convince MHS and Defence to change their approach: “The less doctors that sign up, the better to demonstrate this is no the way to do things”.
The AMA President said that in order to be accepted as a preferred provider, MHS required specialists to accept a significant cut in fees and acquiesce to conditions that had the potential to limit patient choice, constrain clinical independence and compromise patient confidentiality.
Under the new arrangements, which will apply to 100 barracks and bases serving 80,000 personnel, military doctors will no longer be able to refer patients to a local specialist of their choosing.
Instead, Medibank will encourage referral to a practitioner on a centralised database of preferred specialist providers.
Specialists who sign up to the new scheme face onerous demands, including a stipulation that all medical reports be completed and lodged within three days, while accepting a cut in fees of up to 50 per cent.
Dr Hambleton has urged doctors to consider their position carefully before accepting the MHS offer.
“Seek independent legal advice, particularly in relation to the clauses about disclosure of medical records; consult your medical indemnity insurer; and carefully consider the impact of the new fees in light of your practice costs,” the AMA President said.
Many specialists, including anaesthetists and orthopaedic surgeons, have so far refused to sign up to the agreements offered by MHS, raising concerns about the ability of Defence Force personnel to get the care they need.
“The AMA is very concerned that the new MHS arrangements will reduce access to medical services for Defence personnel,” Dr Hambleton said. “In this regard, a number of members have already written to the AMA advising that they will not take up the MHS offer.”
Dr Hambleton said the schedule of fees offered by MHS was “generally much lower” than previous arrangements, and members had advised that the new contracts could potentially interfere with clinical independence and patient choice.
Dr Hambleton said MHS had showed “a lack of understanding” of the complexity of health care.
“What happens when a surgeon is ready to operate, but no anaesthetist can be found?,” he asked.
Dr Hambleton said the lack of consultation by MHS or the Defence Department in introducing the new arrangements was unacceptable but, unfortunately, unsurprising.
“The ADF has a very poor record of consultation on the provision of health services, with consultation normally taking place after the fact,” he said, a situation he said the AMA had hoped had changed following an overhaul of contracting arrangements in 2007. “Unfortunately, the complete lack of consultation by the ADF or MHS is a return to the take it or leave it approach seen in the past.”
Dr Hambleton said that the episode added to concerns about the involvement of health funds in providing health care services.
“It does raise some concerns about the role of health funds operating as service providers,” the AMA President said. “There was a whole lot of assumptions made (by MHS) that were not appropriate.”
Medibank Health Solutions executive, Dr Andrew Wilson, admitted that under its new arrangements, “some providers may be offered a rate which will be lower than what they are used to”, but insisted that this would not compromise the health of enlisted personnel in any way.
MHS claims that 2500 specialists have signed up to its offer, along with 3000 allied health professionals and 112 hospitals.
Published: 05 Nov 2012