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Concerns over insurers’ push to fund GP visits
Proponents have said it would help support under-pressure doctors, but public health advocates are worried it could lead to a two-tiered system.
Dr Harry Nespolon said any proposed reform should not be a way for the Government to avoid responsibility to return funding to where it was prior to the Medicare freeze.
Private health insurers, led by NIB boss Mark Fitzgibbon and Medibank Chief Executive Craig Drummond, have backed policy reforms that would allow them to cover services outside hospitals that currently attract a Medicare benefit, such as GP visits.
The calls stem from a KPMG report that found a shift away from hospitals towards community-based preventive and primary care would lead to fewer complications, lower mortality rates, cost savings and better patient outcomes.
According to Mr Fitzgibbon, Australians get ‘very, very frustrated’ by the inability to cover medical expenses incurred outside of the hospital system with their private health insurance (PHI) policies.
‘I’ve found no policymakers who have yet been able to explain to me the policy logic for limiting our cover to hospital settings,’ he said.
‘For me, the ultimate goal is that we’re able to cover our members wherever they meet the healthcare system, particularly when as a business we’re trying to pivot more towards being a healthcare rather than a sick-care system.’
Healthcare bodies such as the Australian Healthcare and Hospitals Association (AHHA) and Consumers Health Forum (CHF) have expressed caution about any such move, and RACGP President Dr Harry Nespolon told newsGP he would be interested to see the detail of how general practice patient rebates would be covered by PHI rebates.
However, Dr Nespolon added any proposed reform should not be seen as a way for the Government to avoid its responsibility to return funding to where it was prior to the Medicare freeze.
‘The reason there is pressure on the system is because the Medicare freeze ripped about $1 billion out of general practice that hasn’t been replaced,’ he said.
‘By 2023 that figure will grow to around $2.45 billion. Something must be done to close this shortfall, but it should come from Government, not the private sector.
‘Medicare is fundamental to Australia’s healthcare sector and we should avoid any move that risks disrupting universal patient access, or that could create a two-tiered system that excludes the most vulnerable among us.’
KPMG Executive Director Gary Belford, who co-authored the report, told The Australian that allowing private insurers to fund home and community-based case would be an ‘excellent idea’, while Private Healthcare Australia Chief Executive Dr Rachel David is in favour of PHIs being able to cover certain out-of-hospital services such as at-home chemotherapy and non-acute mental health care.
Federal Health Minister Greg Hunt also indicated he is ‘open’ to considering new options for providing care in different settings that would benefit patients, but Australian Private Hospitals Association (APHA) acting Chief Executive Lucy Cheetham called the proposed reforms a ‘money grab’.
‘While it sounds great to have chemotherapy in the comfort of your home, it’s a furphy that it is a cheaper option,’ she said. ‘If not managed well, it raises safety concerns.
‘Having an insurer determining care options rather than a medical professional is a dangerous business.
‘Is this increased interest related to the fact that several health insurers have explicitly stated that they want to diversify their business models and move into the delivery of health services themselves?
‘If health insurers want further reform we need to ensure that this is in consumers’ interests. We need to ensure that irrespective of where the service is provided or by whom, consistent standards apply.
‘We need to ensure that consumers are in the driver’s seat [and] able to access the options that are right for them.’
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