8 August 2016

Concerns mount over insurers’ influence

Health Funds KnowCents Technology

 

Private health insurers and doctors are set to clash over access to information on fees and performance ratings as insurers throw money behind the so-called TripAdvisor for healthcare

Whitecoat, which has been operating under NIB since 2013, allows patients to book and review GP, dentist and other allied health appointments.

So far, about 250,000 reviews have been lodged, and about 10,000 patients book an appointment using Whitecoat each month.

Now with backing from two more insurers, HBF and BUPA, Whitecoat is expanding to cover medical specialists and plans to publish gap fees of individual doctors. NIB chief executive Mark Fitzgibbon says Whitecoat intends to eventually use hospital data to publish the clinical outcomes of specialists’ services. Practitioners will have to agree to sign up to the service.

According to the insurers, the platform will increase transparency around out-of-pocket expenses and expand consumer choice.

“Whitecoat is another example of how the digital world is shifting power away from the ‘sellers’ of goods and services to the ‘buyers’. Whitecoat reflects this trend. It is pro-consumer,” Mr Fitzgibbon said in a statement.

But some GPs have major concerns about the potential for the commercial interests of insurance companies to distort information on the website.

“The insurers already wield a great deal of power in this space,” AMA President Dr Michael Gannon told The Medical Republic.

“The insurers now own general practices, they own hospitals, they own diagnostic imaging companies, they own pathology companies.

“And the final aspect of the market that they would seek to control is the information that patients get.”

A major concern is that such websites promote a US-style system where private health insurers dictate which providers patients can access, based on the insurer’s financial interests.

“We understand the imperative for the insurers to control costs,” Dr Gannon said.

“But what we don’t want to see is yet another layer of control, and what we definitely will fight to the death is anything like US-style managed care where it is your health insurer that determines the care you get, how much care you get, not your doctor.”

A spokesperson for BUPA told The Medical Republic that Whitecoat did not currently promote certain practices or practitioners based on their commercial relationship with the insurer.

However, the website may allow health fund members to access information about the insurer’s preferred providers in the future, the spokesman said.

A further concern, Dr Gannon said, was that insurers would “splash complication rates all over a website” and potentially lead some doctors to cherry-pick cases to reduce risk.

For example, surgeons might avoid operating on the morbidly obese, smokers or other groups at high risk of complications.

“If you start reporting infection rates or return-to-theatre rates, that might mean that some of the neediest patients in our community are denied care,” he said.

However, BUPA managing director Dwayne Crombie said ratings would be carefully handled so that surgeons were not deterred from treating high-risk patients.

Dr Gannon said the most effective mechanism for quality control was a GP, who could help patients find a specialist suited to their particular needs.

While any member of the public will be able to access some information on doctors, only health fund members will be able to see what doctors’ out-of-pocket charges and performance ratings are.

 

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Dr Lou Lewis
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Dr Lou Lewis
2 years 2 months ago
General practitioners and patients should be afraid, very afraid, the way that medicine is heading. This latest Whitecoat website is not the first salvo in the war to change our medical system but is is one of many. The one that comes to mind is when in the last year or the year before the general manager of Medibank Private suggested that patients who are privately insured should get preference over in noninsured patients in ED. Than the second one that comes to mind is that the BUPA is trialling a system where a doctor will only treat the privately… Read more »
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