Concerns over insurers’ push to fund GP visits

Matt Woodley

30/10/2019 3:35:31 PM

Proponents have said it would help support under-pressure doctors, but public health advocates are worried it could lead to a two-tiered system.

Medicare and cash
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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Dr Oliver Frank   31/10/2019 7:50:04 AM

There are two strange aspects to private health insurance in its current operation.

The first is that it pays for quite small costs of routine health care such as seeing a podiatrist, which the insured person in most cases can well afford to pay for anyway, rather than paying only for rare (for most people) major costs of serious illness or major surgery that the average person could not easily afford to cover.

The second strange aspect is that private health insurance is not actually private, because it is partly funded by government via foregone income tax revenue (the private health care tax rebate). if private health insurance was funded entirely out of the insured person's AFTER-tax income, private health insurers should be allowed to insure their customers for anything that the customers want to be insured against.

In my early days in practice, private health insurance paid for the gap between the (then) Medibank benefit and the schedule fee.

Dr Emma Keeler   31/10/2019 10:33:53 AM

My only concern would be moving toward an American type system where there is very much a tiered system. As a GP and business owner I am concerned about the push for insurers to start providing healthcare services. I am also concerned about us going down a path as discussed in the article where the treatment decisions are made by the insurer (with a financially based decision) versus individual patient and general health system based decision. We have to think laterally and look at how to better service patients and support General Practice, but also be mindful of the fact there is lots of money in health care and making sure changes will give us the health care system we want in the future.

Dr Umberto Boffa   31/10/2019 10:49:37 AM

No-one need worry - PHI would go broke in a year if they attempted to cover non admitted medical services (except the small number that truly substitute for in-patient care) and I think the advocates for this within the industry need their heads read.
Bert Boffa
Ex- PHI medical director.

Dr David Christopher Rivett, OAM   31/10/2019 12:10:31 PM

Federal Funding for GP Care is shrinking and will continue to do so with a rubbish based formula for indexation
Private Funds can subsidize all manner of allied healthcare, so any argument about now adding GP insurance creating a 2 tier system is not based on the real world.
Certainly a 2 tier system has been created very deliberately by the Federal Government and that must be recognised and the blame for such placed firmly with the Federal Health Minister.

We should champion any new funding avenues to let GPs keep their doors open, while being wary of any Insurers strings attached to funding.

Dr Peter James Strickland   31/10/2019 12:23:19 PM

The reverse should be occurring here also, and that is that those attending Emergency Departments at hospitals for non-hospital admission reasons should be charged a fee beyond the GP set-fees. That would encourage more attendance at GPs and allow GP clinics to employ more doctors and staff, and have an after-hours service. All that would save a fortune in hospital costs, and which are the really expensive part of our health system here in Australia. Cutting back on GP costs is 'cutting off your nose to spite your face', and almost certainly related to some federal bureaucrat(s) sitting in an office not knowing really where the real costs are generated in healthcare, and how.

Dr Horst Paul Herb   4/11/2019 3:25:20 AM

Can anyone please name a single health system on this planet where private insurance for primary care has improved either patient outcome or GP satisfaction without inflating costs to the detriment of society as a whole? Just one?