AMA Transcript - MBS review and Medibank Private

BRIAN OWLER: Well, thank you very much for coming out today. There are two things that I want to talk about today. The first is this ongoing dispute with Medibank Private and the Calvary Health Care group. And the second is the process of the MBS reviews, and I've just come from a meeting of about 70 representatives of colleges and specialist societies.

This issue with Medibank Private and Calvary represents a pivotal point in our healthcare system. The ongoing behaviour of Medibank Private, its insistence on applying this list of 165 so-called highly-preventable events, as well as this issue about not paying for readmissions within 28 days, is going to create uncertainty for patients in the ACT, Tasmania, and South Australia in particular. There are many patients there that will be facing out of pocket expenses, who have Medibank Private policies.

This issue has nothing to do with quality. They are using the cloak of quality to cut costs, to not pay for treatments and procedures, and this is going to put an enormous strain on our hospital system - not just in terms of the private system but the public system as well. We know that there will be patients that won't be able to be readmitted should they develop problems with their wound or other complications, and they will have to go to the public hospitals. There are other patients that won't be able to afford the out of pocket expenses that Calvary will have to charge, and they will have to be going to public hospitals as well.

Now, as I said, this is a particular problem for the ACT, South Australia, and Tasmania. But this issue, if it is not stopped by this Government, by the Minister, has the ability to threaten the balance between the public and private system right across the country. We've already seen Bupa and NIB line up behind Medibank Private.

Now, the AMA has nothing to gain in this argument, except to say that we will not stand by and let Medibank Private continue to act in this manner. Today they have taken out a full-page ad in various papers around the country, again trying to set the record straight. What they are doing is continuing to be mischievous with the truth. These are not mistakes, these are complications that are unfortunate but part of everyday medical practice. And while there is a degree of preventability, they are not mistakes, they can not be completely prevented. And what they are doing is unfairly punishing the hospital, blaming the doctors and the nurses that are working and caring for patients in those private hospitals, and going to put an enormous strain on the public hospital system. Patients with Medibank Private policies, particularly in these states where Calvary is a very strong group, are going to continue to face uncertainty.

At the moment, what we have is the fox in the hen house. And, as every farmer should know, the fox doesn't just stop at one hen, it continues until they're all gone. To say that the Government does not have a role in this dispute is ludicrous. First of all, this dispute is in part the creation of this Government. It was this Government's policy that actually put Medibank Private on the stock exchange, created the biggest private health insurer where the responsibility was now the shareholders and concentrating on returns to investors. To say that, in perhaps the most highly regulated part of the economy, with the exception of banking and finance, that the Government doesn't have a role is ludicrous. The Government also has about $6 billion of skin in the game; they pay for the private health insurance rebate, they support private health insurance, and this move by Medibank Private continues to undermine it.

And we call on the Minister, Sussan Ley, who I've spoken to about this issue, to step in and stop this from continuing to happen, get them to work with the Commission along with the other insurers, alongside clinicians and the private hospitals, to work on ways we can improve quality in our private hospital system, and make sure that we continue to have that proper balance between public and private hospitals.

I also wanted to talk about the MBS review. The MBS review is a centrepiece of health policy for this Government. The AMA supports having a schedule that represents a schedule that allows patients access to modern medical procedures, and reflects the modern-day treatments that are provided in our hospital system, both in the public and private sectors. The MBS review does have the potential, however, to run off the rails if it becomes a cost-cutting exercise. We need to make sure that the Government continues to work with clinicians, that this is a clinician-led process that is based on evidence, and that the process is held in conjunction with the colleges and specialist societies where the knowledge base and expertise lies.

We also need to make sure that we can have the ability to put new procedures, new treatments on the schedule. This should not just be about taking procedures off.

So, the AMA will continue to work with the Government in the review, and we will work with the specialists and colleges in making sure that we get the best outcome from the review - provided this is not just about cutting costs and provided that we maintain access to health care for our patients.

QUESTION: Is it concerning that the Government is keeping quiet on the Medibank issue?

BRIAN OWLER: It is concerning. As I said, the Government seems to think that this is simply a commercial dispute. What they fail to realise is that this is a pivotal moment in our healthcare system when it comes to the private health insurance industry. They can continue to stay out of the game, or they can get involved and start to fix up some of the mess that they've created.

Now, we warned, before Medibank Private was listed, that they would be creating a problem with private health insurance, and that Medibank Private in particular will be behaving in a manner that was in the interests of shareholders primarily, making sure that they grow market share, get that return to investors. It becomes not about the patients and the members anymore, and having Medibank Private as the biggest insurer in the market really distorts the market. Now, the Government can regulate, there is no doubt about that. This is one of the most highly regulated sectors in our economy, and for good reason - to protect our patients from abhorrent behaviour by certain groups or companies that might try to influence things for their own gain.

So, again, $6 billion worth of private health insurance rebates that are in the system that are provided by the Government - this Government has skin in the game, and to say that they just want to stay out of it, I think they're missing the point, that this is going to be something that starts to spread across the healthcare system, and will really affect those patients with chronic disease. So, those patients that are the sickest patients, those patients with chronic diseases and more complicated illnesses, they're the ones that are going to suffer from not being able to be readmitted within 28 days. Or hospitals are going to start to not accept the risk, because they're not going to accept the risk of them developing the complications. And we're seeing the evidence more and more come out of the US to say that many of these events are - as hard as people might try to avoid them - are not purely preventable.

In fact, many of the factors that precipitate these events are actually patient factors that we can't change, and that is part of the nature of the practise of medicine. We strive every day for quality, to improve the care of our patients, but we cannot prevent every complication from occurring, and again, if Medibank Private persists with this being about mistakes and improving quality, they continue to be very mischievous with the truth, and these ads are part of that process.

QUESTION: Professor Owler, you're talking about preventability - isn't the only way of preventing a patient from falling over and breaking a bone in hospital tying them to the bed?

BRIAN OWLER: It is, and you can talk about chemical restraint, mechanical restraint - we're not going to do that to every patient. We can put people at the bedside, and I've seen cases where you've had nurses on vigil with the patients at the bedside, but you still get confused patients that climb out of bed in the middle of the night when someone thinks they're asleep. They might duck out for five minutes. And patients can still climb over the rails. But there are other problems as well, like infection. Now, I can tell you as a surgeon, I strive to try and make sure that my patients don't get an infection, because not only is it bad for the patient, it's bad for the hospital, and we don't like having infections. We want to make sure that we get the best outcomes for our patients, and we want our practices to strive to be of the highest quality. It's our reputations that are on the line.

Now I can't, unfortunately, prevent every infection from occurring despite my best efforts. And to use financial motives as a way of trying to improve quality is really something that has not been shown to work overseas. It's not working in the US, in fact they're going away from that method, and I think it's really - we need to call it out for what it is. This is about saving money at the expense of our patients.

19 August 2015

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