MEDICUS FEBRUARY 2016

C O V E R S T O R Y AGED CARE Y STEALTH Are private health funds removing choice from consumers while slugging them with higher premiums? I n his first speech as AMA (WA) President, Dr Michael Gannon spoke strongly about preserving in the doctor-patient relationship, creating mounting concerns about the increasing cost and commercialisation of healthcare. And secondly, is managed care in Australia becoming an inescapable reality?

the sanctity of the relationship that develops between a doctor and their patient. “At the core of medical practice is the doctor-patient relationship. I will fight anything that attempts to come between doctors and patients, be it private health insurers, government cuts, the health bureaucracy or other health workers seeking to substitute themselves for a doctor,” Dr Gannon said in June 2014. At the same time, he and the Association he leads here in Western Australia understand that collaboration is key to progress. A siloed approach to any issue would not result in positive outcomes – for the patient, the doctor or even the highly competitive, low- margin business of Private Health Insurance (PHI). In recent months, the PHI industry in Australia has come under the scanner with insurers attempting to intervene Close to two years later, Dr Gannon remains committed to his words.

The American healthcare system brims with lessons from which we can learn. No doubt, their achievements in research, technological advancements and innovation are reasons to stand back and congratulate them. Yet at the patient end of the spectrum, the American healthcare structure is criticised for being driven more than most health systems by dollars. Other criticisms include low accessibility to quality care for lower income patients and a tendency to embrace an extended scope of practice that sees non-clinicians performing duties without adequate training, thereby increasing risk. Let’s not forget the US spends almost 18 per cent of GDP on healthcare; Australia and other comparable countries spend around 9 per cent. While Australia may be some time away from following in America’s footsteps, industry watchers say the warning signs are becoming too obvious to be ignored.

Federal Health Minister Sussan Ley who is overseeing a review of the $19 billion private health insurance sector, wrote to all 35 health funds late last month asking them to either lower their requested premium increase or justify their initial request. Amid a pitched election year battle over health spending, Minister Ley’s intention is clear – a better deal for PHI consumers. But the insurance sector has hit back, calling the move an unprecedented departure from regulatory process. Health funds argue that premium hikes had been limited to 6.18 per cent last year while healthcare costs had risen at 6-9 per cent and benefits paid out jumped 7.4 per cent to $17.2 billion. As the debate heats up, the question must be asked: Just who is in control? Who has the final say when it comes to a patient’s care? Is it the clinician, the hospital or the private health insurer – the moneyman clutching the purse strings?

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