Managed care threat to Australia – AMA

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The Australian Medical Association (AMA) has cautioned against private health insurance companies having too much power over clinical decision making in a recent interview.

AMA Vice President Chris Zappala told Nathaniel Keesing’s The Daily Show there was a genuine threat of Australia emulating the United States where insurance companies dictate what care can be offered to patients.

“Unfortunately, we’re seeing early signs that our health system is starting to slip the same way [as the United States]and insurance companies are making a grab for that sort of control over an individual’s health, which is just totally unacceptable. We call this managed care and its always been against everything that we believe in in Australia, for good health care for our people,” Dr Zappala said.

He said doctors were already frustrated that they had to contact private health insurers to get approval for particular treatments. He warned the increased number of ‘for profit’ private health insurance funds meant the focus was changing from care to profit.

“More than a decade ago, only about 15 to 20 percent of the private health insurance companies in Australia were for-profit. But now, unfortunately, in 2019, nearly 70 percent of all the companies in the private health insurance market are for-profit... And that’s been a significant shift over time.”

He said these were indicators that Australia was headed down the road to managed care and called for legislation to compel health insurance companies to have a set amount they would pay out for procedures.

“A third thing we see is that you can go and have, for example, a hip operation, and one health insurance company might give a reasonable rebate for that, but then another insurance company will give half, less than half, of that same amount for the same service. It makes no sense whatsoever…So I think they’re the indicators that we’ve got that we really need to take up and take some notice now and make sure we don’t go the way of managed care in the US,” he said.

Dr Zappala said addressing the issues around private health insurance and rebates was important for a number of reasons, not least of which was the increasing pressure low private health insurance participation would have on public hospitals.

“We need to remember that as people are leaving private health insurance and there’s a steady decline, the public system can’t handle these increase waiting lists. So we’ve got to get this right for everyone’s collective benefit,” he said.

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