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14 Mar 2018

ASSOCIATE PROFESSOR JULIAN RAIT OAM
CHAIR, AMA COUNCIL FOR PRIVATE SPECIALIST PRACTICE

The Council of Private Specialist Practice (CPSP) met on February 15 to discuss a number of important issues facing private practice in 2018. The priority issue for 2018 is to condemn the false narrative that doctors’ fees are the cause of most private health insurance out-of-pocket costs (OOPC).

Members may be aware that the AMA is participating as a key stakeholder on the Ministerial Advisory sub-Committee on OOPCs, which aims to identify drivers for patient out-of-pocket costs and explore strategies that may improve the provision of information for consumer choice and, and fee charging practices of medical practitioners.

While the OOPC conversations are largely still in confidence, it’s no secret that the Government is exploring medical fee transparency models aimed at consumers, including a ‘Trip Advisor’ style rating website.

While the AMA has expressed in principle support for fee transparency and informed financial agreement with patients, CPSP rejects outright the health insurers’ allegation that doctors are responsible for diminishing the value of private health insurance. This belief oversimplifies a complex, systematic issue and ignores the real culprits of high out-of-pocket costs, which are inadequate MBS and PHI rebates.

Consequently, health reform requires a comprehensive approach. 

At the outset, it must be acknowledged that Medicare was never intended to cover the full cost of medical services. At the same time, Medicare and PHI schedules have not been sufficiently indexed to cover the costs of ever-evolving modern practice. Since 2014, the Medicare freeze has cut significant dollars out of the health system. Thankfully, AMA advocacy saw the incremental lifting of the Medicare freeze in 2017. We look forward to the lift on specialist consultations from 1 July 2018. But it is still only a small improvement.

Secondly, private health insurance is becoming increasingly problematic and confusing for the Australian customer - higher premiums with ever-changing and increasing policy exclusions are resulting in significant and unexpected gaps. This is evidenced by the significant number of complaints to the PHI ombudsman regarding PHI insurance policies (rather than about practitioners).

Finally, we need to recognise the complexity of a situation where there are multiple practitioners involved with a procedure, associated with the recent disturbing development whereby no-gap and known gap arrangements are soon to be linked by Bupa as to whether a facility has a contract.

To counter this, the AMA will continue to engage with the Government on the development of an improved PHI system that offers a simplified, more comprehensive set of coverage, with clear clinical definitions, and less caveats and carve outs. This, if achieved, would hopefully restore the public’s faith in private health insurance. 

Certainly, the profession has kept the faith, and against all odds APRA statistics continue to highlight that the overwhelming majority of medical practitioners bill their patients under a no or known gap billing arrangement (95 per cent). It is difficult to argue with these facts and that the overwhelming majority of practitioners continue to assist patients in limiting their out-of-pocket costs.

That said, CPSP members have acknowledged that their remains a very small cohort of medical practitioners who, through inappropriate billing practices, undermine the broader profession’s intent to provide high quality medical services at fair and reasonable costs to their patients. These practices include the use of booking fees, split bills and/or billing for items that are not linked to MBS or AMA scheduled items. CPSP, with the support of the President, have taken a position to curtail this type of billing behaviour.

Of course, all of this work will only be successful if we improve the most critical factor - health literacy. The Australian Commission on Safety and Quality in Health Care reports less than 60 per cent of Australians have inadequate levels of health literacy. We can’t expect Australians to navigate the complexity of our health system without the right tools and greater knowledge.

Furthermore, it is clear that the issue of patient out-of-pocket costs is far more complicated than the media have been reporting, and that CPSP will need to work with other AMA committees and the wider clinical craft groups to convey this to key policy makers. The rights of private medical practitioners to set competitive fees in line with their expenses, their expertise and each patients’ unique circumstances are well established.

At the heart of the matter is the fact that some members of the private health insurance industry are becoming more profit driven and not taking responsibility for their role in supporting the system. As a result, many customers are leaving for the already overstretched public system. As many have said before, we need both sectors to be in balance in order to have a sustainable health system.

As the AMA, our role in this debate is as much to advocate for the patient as it is for ourselves – a fairer, clearer and better value system that balances the interests of all stakeholders.


Published: 14 Mar 2018