AMA calls for private health insurance reform

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Australian Medical Association (AMA) President Dr Michael Gannon has suggested the practice of public hospitals targeting privately insured patients to raise revenue ‘’wouldn’t always pass the sniff test’’ during his National Press Club address this week.

Dr Gannon, who praised the private health system as taking pressure off public hospitals in his speech, said there needed to be flexibility so people with genuine need could use their private health insurance in the public system, but public hospitals needed to be providing better care and value to patients to justify accessing insurance benefits.

In his annual address the AMA leader said the private health sector was a pillar of Australia’s health system that kept the pressure off the public system.

“Our public hospitals would not survive without the support of our private health system… Australia’s health system relies on the dual system of public and private health. The two complement each other.

“But we also need to talk about private health as a critical component of taking pressure off the public system. As a forceful advocate for public hospitals and those Australians who do not have the luxury of a choice, I am therefore an advocate for private health,” he said.

Dr Gannon warned that Australia must reform private health insurance or risk losing essential elements of health care from the private system.

He said private health insurers needed to take their share of the responsibility for the problem if they are not providing policies that are affordable, comparable and understandable to Australians.

Dr Gannon also attacked ‘junk policies’ which he said provide little more than what patients can receive in the public system, but makes them pay for it.

“Doctors have a complicated relationship with private health insurance. Indeed, private health insurance itself is complicated.

“There are more than 20,000 policy variations around the country. They are littered with inconsistent terminology and a bewildering array of exclusions, caveats, carve-outs and excesses. There are policies out there that offer inappropriate cover,” he said.

Dr Gannon raised concerns about the market power of the private health insurers and the impact they are having on clinical decisions.

“They are deciding who can provide what treatment, and where they can provide it. We have situations where clinical decision making is being questioned, and overridden, in some cases, by insurers. If this shift is allowed to flourish it will undermine both the private and public systems,” Dr Gannon said.

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