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28 Aug 2019

AMA President Dr Tony Bartone has called for health insurers to increase the rebates they pay to doctors in order to reduce gap payments.

He described the blaming of doctors for out-of-pocket costs as a devious ploy by private health funds to distract attention from their failure to pay adequate rebates for health care.

Dr Bartone’s remarks follow reports from within the private health insurance sector suggesting doctors should be paid less in order to reduce gap payments.

Nib boss Mark Fitzgibbon said insurers should be able to guide their customers to doctors who charge a fair price.

But Dr Bartone said doctors’ fees was not the problem. He said some insurers were only driven by their own profits.

Nib recently reported a 9.2 per cent lift in annual profit to $201.8 million.

“We know for a fact that the gaps occur because of, particularly, rebates from insurers, which have not kept pace with the cost of providing good quality care,” Dr Bartone told Sky News.

“Now, what they’re seeking to do here is to try and manage your care. That is, try and direct your care to the lowest common denominator .. from a price perspective … that’s all they’re interested in.

“They’re not interested in your care. They’re not interested in the level of quality that you’re getting. They just want to manage your care to a price and therefore continue to make the increasing profits.

“The gaps occur because those rebates have not kept pace with the cost of providing care and we know for a fact that if you compare funds, and you compare across the States and policies, those rebates vary considerably between the best and the least accommodating of the lot.

“So, blaming doctors for the gaps is really quite a devious ploy to try and distract from their attempt to try and manage your care.

“A lot of the cost, a lot of the surprise, is when you think that you’re covered for something and you find out that you’re not covered or that you’re actually having to put your hand in the pocket for more than you thought.”

In a separate interview with The Australian, Dr Bartone said many insurers were not paying a fair price for services.

“Some are not even coming close to covering the cost of providing that care,” he said.

“That gap between the cost of provision of service and what they are paying is getting larger. That is what is creating the out-of-pocket gaps. If they were paying a fair fee, we wouldn’t have that.”

He said that up to 96 per cent of privately covered healthcare services had either no gap or a known gap, which he said was generally about $500.

Dr Bartone has stressed that private health insurance is a vital component of the nation’s health system and that Australians wanted and deserved value cover from transparent policies and reputable health funds.



Published: 28 Aug 2019