Is this really the best you’ve got, association asks DoHAC.
The AMA is pushing for the Department of Health and Aged Care to go further with proposed reforms to the private health sector, arguing that “the lack of genuine reform” over the last 20 years has left the system in need of root-and-branch overhaul.
DoHAC’s consultation paper on private health reform options lays out reforms across six areas: second-tier default benefits; private hospital cash flows and administrative costs; patient access to hospital-in-the-home programs; overseas-trained psychiatrists; accessibility of maternity care; and risk equalisation in insurance.
In its response, released this week, the AMA said it supported most reforms but “would be frustrated and disappointed if it stopped there”.
“The private health system needs reform beyond changes to how insurers pay hospitals for servicers or how contracts are negotiated, it needs reforms that improve the entire system and deliver benefits for all involved — clinicians, consumers and government too,” the association said.
The biggest area of concern was related to a recommendation to lift the 10-year moratorium on internationally trained doctors billing Medicare, but only for psychiatrists.
“[Section 19AB of the Health Insurance Act 1973] already directs overseas-qualified medical graduates towards working in areas of need, and if 19AB is amended for the psychiatrist workforce, it risks completely denuding the most under-served regional and rural communities of a psychiatry workforce, given that private psychiatry services in many city areas are also underserved and would gladly hire them,” the association said.
It also had a dire warning about private maternity care, which it said would essentially cease to exist unless private health insurers were forced to include it in more than just “gold” level policies.
Another specific issue that the AMA picked up was in relation delayed claim payments by insurers, which negatively affect private hospital cash flow.
Related
The consultation paper suggests implementing a moratorium on private hospitals’ benefit claims that remain unactioned after a reasonable period, following a period of whole-of-sector feedback.
The AMA fully supported that course of action, but wanted to see action taken which would result in a “meaningful immediate impact” on all policy holders.
“Currently, there is no mechanism that hospitals or patients can use to resolve delayed payment other than patients seeking the help of the [Private Health Insurance Ombudsman],” it said.
“Australia cannot risk a shift towards the managed care environment that has emerged in the United States of America, where it is reported that legitimate claims are routinely denied by private health insurers almost as a default setting, often with serious health-related and financial consequences for patients.”
The medical association was also concerned that, without a clearer definition, the proposal to make private health insurers put a minimum level of funding into hospital-in-the-home programs could backfire.
While the AMA understood it to mean programs for which insurers are required under law to provide benefits to hospitals and patient, other stakeholders interpreted it to mean mandated at-home care for certain medical conditions.
The latter proposition, the AMA said, would be “untenable” in terms of clinical judgement and patient safety.
