The health insurance giant quietly announced plans to build out its connected care vision by acquiring general practices.
Multinational private health fund Bupa is in the market for GP clinics, raising new fears about managed care – but this is a problem of the government’s own making.
The insurance giant unveiled its grand plan in June, announcing that it would focus on acquiring healthcare centres with integrated GP, allied health and pathology services as part of a multi-year investment in expanding its current services.
It already owns more than 200 dental, optical and hearing clinics.
The proposed clinics, of which two are already up and running, will be open to the general public (i.e. not restricted to existing Bupa health fund customers).
Bupa’s Asia-Pacific CEO Nick Stone said the expansion into general practice will give members a “truly connected health journey”.
“As part of our Connected Care vision we will build out and bolster our preventative health programs including nurse and dietitian-led health coaching, mental health and wellbeing programs, and programs to help people avoid or recover from a health condition,” he said.
It has set off alarm bells at groups like the AMA.
“The AMA does not believe that it is possible to reconcile the conflict of interest inherent in a vertically integrated organisation that spans both the funding and the provision of care,” association president Professor Steve Robson told The Medical Republic.
Private insurers being permitted to buy into healthcare delivery at all was a “major concern”, he said, and called for an independent regulator that could protect doctor independence.
“Regulatory oversight of this part of the sector is entirely prudential and competition based – there is no one considering the impact these models will have on our health system or patient care,” said Professor Robson.
Bupa wouldn’t be the first insurer to dip its toe into general practice.
In December last year, Medibank upped its stake in corporate chain Myhealth to 90%, while Nib owns the online telehealth-only clinic Hub.health.
Dr Mukesh Haikerwal, who is deputy chair of clinic owners group Australian GP Alliance, told TMR that while managed care posed a real threat to the Australian health system, there weren’t many other options for general practice funding.
“Talking from personal experience in trying to provide services outside of the normal Medicare Benefits Schedule – if you do anything different, you just can’t get funding for it,” he said.
“A little bit might be coming out of Primary Healthcare Networks, but not very much.
“There’s nothing out of Commonwealth and very little out of states … so you can see why coming from out of the box can be a benefit.”
As a practice owners group, Dr Haikerwal said, AGPA would like to see clinics owned by GPs – but the next best thing, he acknowledged, was clinics being run by GPs.
When it came down to it, health funds also made a slightly friendlier bedfellow than private equity.
“One of the potential pluses you could get from a group like private health insurers getting involved is … that they have to provide private health insurance and that needs to be good value for money,” the Melbourne GP said.
“Their expenditure on the private health insurance side becomes less if they have good general practice care.
“I suppose the bigger game [for insurers] is Australian healthcare, as opposed to venture capital, which may have a different driver.”
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It’s a line of reasoning that Private Health Australia CEO Dr Rachel David also took.
“If people have conditions that go undetected in the community and gets worse and worse until they go to an emergency department or hospital, that’s bad for [insurers],” she told TMR.
“The cost of their care is so much more expensive if cancer gets missed or if their cholesterol doesn’t get checked and next thing you know they’ve got coronary artery disease … that is a disaster.”
Dr David also said that, in any case, the laws in Australia which forbid private health insurers from covering GP-style out of hospital consults or directly employing a private doctor are too strong to allow US-style managed care to take root.
Still, the failings of successive governments to keep Medicare viable have left a market gap that the current government is struggling to fill.
“I think there is a role for some big practice payments to be made into general practice to assist with more preventive work, and that’s [where] that the health funds … [can], in some ways, try to step into the breach,” said Dr David.
