Private Medical Insurance and GPs – an inevitable process?


Australia’s legislation is clear about the role of Private Health Insurance in the General Practice environment – clear in that there should be no such role.

The various Private Health Insurers have over the years tried to find ways of circumventing these rules – after all this is a huge untapped source of potential investment for them.

One of the first examples of this was when Medibank Private and the IPN group joined up in a partnership in Queensland in 2014 – this may actually still be taking place.

Everytime this issues raises it’s head there are concerns raised by various parties – well known Health Policy Experts , The AMA and the RACGP are some of the many people and organisations who are concerned about the implications of such arrangements.

While the current legislation explicitly prohibits a direct involvement in the provision of GP services the Insurers, and even the Health Department and Minister, are constantly trying to find subtle ways around this.

Currently we have two examples of this happening in the ACT:

a.  The National Home Doctor Service

This Nationwide after hours GP service has a close association with BUPA  with a model in which:

  1. Patients can call and request a Bulk billed home visit for whatever condition they desire
  2. A Doctor (often not a fully qualified GP) attends and sees the patient
  3. If the patient is a BUPA member the doctor provides a variety of medication on the spot free to the patient – which BUPA pays for. As far as I know no Pharmacy or second person is involved in the actual final process of dispensing medication to the patient and a number of checks and balances are therefore no longer in place

b. The National Health Co-operative

This organisation is currently the biggest provider of GP services in the ACT. While Medicare legislation clearly prohibits  any out of pocket charge when a patient is bulk billed the Co-op has, with the weight of some very powerful political support in the ACT, manage to work their way around this by charging an annual membership to patients in return for being Bulk billed.

This process is, in the words of a senior Medicare Compliance official, not in the “spirit of the legislation” but at the same time Medicare chooses to look the other way and not comment on it publicly in any form or fashion.

As an aside I was advised by Medicare to get my own legal advice if I was to consider a similar scheme – this I did and I was told by my expert in no uncertain terms that the legal team thought this was not an acceptable scheme for me to trial – obviously the Co-op have different lawyers as they are very confident that their scheme is legal and valid and I am sure that they will have the arguments to back that up.

In December 2015 a new layer was added to this process – HCF sent out a letter to all their ACT Members that they will pay for their members to switch from their current GPs to the Co-op.

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We therefore have a situation where a private Health Funder is actively encouraging their members to change their GPs to a preferred provider and in return the patients would receive free services – what is off course totally unknown is what the Health Insurer receives in return. The only clue lies in the fact that their members would receive a comprehensive check at the Co-op when they sign up.

 

One can only but speculate what this entails but I personally do not for one second believe that any of these insurance companies would be getting involved in GP service delivery for altruistic purposes. It is hard to know as there does not seem to be any easy to find reference to this arrangement on either HCF or the Co-op’s websites.

Finally, it would appear that the Media is highly selective in their interest in these matters. When I became aware of these arrangements I was unhappy – at face value it appeared to be bordering on a very “interesting” application of the legislation and, frankly, my patients were being poached with the help of an Insurance company.

 

I attempted to make our local Media aware of this – letters and communications to our local ABC, 2CC and the Canberra Times were totally ignored.

This entry was posted in Health Insurance, Medical Admin, Medical ethics and tagged , , , . Bookmark the permalink.

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