Differing views and opinions on Australia’s health care insurance

private health insurance reform 2017 (1)The government’s process of reforming the private health insurance sector in Australia has drawn a range of criticisms and opinions from organisations including the Australian Dental Association (ADA), the Australian Medical Association (AMA), the Dietitians Association of Australia (DAA) and the Royal Australian College of General Practitioners (RACGP).

Dr Michael Gannon, President of the AMA viewed the reform as a chance to bring clarity, affordability and most of all, transparency to private health insurance (PHI). He said that a strong and viable private health sector is essential, to be able to uphold Australian health system as one of the world’s best.

“The challenge now is to clearly define and describe the insurance products on offer so that families and individuals – many of whom are facing considerable cost of living and housing affordability pressures – have the confidence that their investment in private health delivers the cover they are promised and expect when they are sick or injured,” said Dr Gannon.

The AMA welcomed the decision by Health Minister Greg Hunt to present different categories (Gold, Silver, and Bronze) for PHI policies with standard clinical definitions applied. The AMA has expressed its willingness to give their full cooperation with the government and other stakeholders to ensure that the desired outcome from the reforms will be delivered.

The RACGP has a similar take. They see the reform as a start, but one that needs further work to improve the policy transparency. RACGP President Dr Bastian Seidel welcomed the changes, specifically the offer for more mental health services.

“What sounds affordable now could turn into a huge problem in the future when patients discover they have to pay an extremely high excess. Australian patients want transparency, not clever marketing” Dr Seidel said. He also commended the government for eliminating many non-evidence-based treatments from the list covered under PHI.

ADA President Dr Hugo Sachs also appealed to the transparency of these policies. He said that PHI is thought to be giving choices to consumers, but, actually, the system only offers differential rebates based on who gives the service and limits the choice.

“If you hold an extras policy with a health fund then you should get exactly the same rebate as anyone else who holds that policy regardless of where you live or which dentist provides the treatment.” Dr Sachs said.

Reforms to PHI legislation that addresses the principle of unpretentious choice and rebate fairness that follow on from community rating and as applies in Medicare, is one of the ADA’s recommendations.

The Dietitians Association of Australia (DAA) has said that nutrition is the main factor to prevent and treat a wide range of illnesses affecting Australians. Hence, they cited a few points regarding the current PHI policies and suggestions for its reform.

  • Co-payments and medical gaps effect financial and health outcome
    • Consultation times for APDs are inadequate – as such, DAA considers it well justified that 
      • The level of subsidy for individual dietetic consultations be raised so it reflects the cost of accessing services more 
      • The limit from 5 services per annum be increased to 10 in total  
      • The options for longer consultations be provided 
      • The freeze on indexation for Medicare be lifted 
  • Private health insurance product design including product exclusions and benefit levels, including rebate consistency and public disclosure requirements 
    • ‘Dietitians’ and ‘Nutritionists’ in the same category 
      • The difference between a dietitian and nutritionist must be known to consumers, so they may receive the right services they deserve
    • Rebates for dietetic services is not adequate  
      • Increased and extended private health insurance rebates for dietetic services, is the aim of DAA 
    • Health & wellbeing services with a weak evidence base
      • Private health insurers having an important role to play in primary health care by covering services for which there is a strong evidence base, was suggested by DAA 
    • Partnered health services for people with mental illness  
      • APDs funded to work alongside psychologists, social workers and occupational therapists under the Better Access Initiative mental health items is aimed by DAA 
    • Partnered health services for people with eating disorders  
      • To mitigate the substantial household economic burden experienced by patients with an eating disorder who are undergoing care is the aim for the need for more sustainable and affordable treatment models within the public and private systems 
  • Methods of medical services delivery including health care in homes and other models 
    • For allied health practitioners 
      • Telehealth and case conferencing 
        • Expansion of private health insurance coverage of dietetic services to include telehealth and home visits as options for initial and subsequent individual consultations is encouraged by DAA. An incentive for participation in multidisciplinary case conferencing would be an additional item for allied health professionals under the MBS to improve the quality of care. 
    • Model of health care homes 
      • The incentives for allied health involvement in Health Care Home services and incentives for allied health to be part of multidisciplinary case conferencing can improve the quality of care for Australians with chronic and complex conditions. 
    • New products to support self-management  
      • For the health professionals to increase their capacity in self-management, DAA would like to see new products developed which provide consumers with value for money and support them to consult 

The discussion about the reform of the PHI policy could be endless, as there are so many loopholes with the current system. However, these associations and practitioners have one thing in mind, the goal to provide the consumer with a real, unpretentious PHI policy, which will benefit not only specific groups of clients, but also every paying individual who deserves the proper care and treatment regardless of the place or practitioner giving the service.  

As Dr Gannon previously said, “Basic cannot mean worthless.” 

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