Recent moves from health insurers have set alarm bells ringing, but the health funds say there’s nothing to it.
The AMA has labelled private health fund Bupa’s move to expand its network of medical centres as “aggressive” and “a major red flag” – but Bupa itself says it has no interest in seeing the laws change.
Last week the multinational health insurer seemingly confirmed plans to become Australia’s second-largest GP corporate by opening or taking over 130 medical clinics over the next few years.
On Monday it went further, announcing plans to open a network of 60 mental health clinics.
While Australian law prevents private health insurers from funding out-of-hospital care for which MBS items already exist, it’s been enough to set alarm bells ringing at the AMA.
“We are concerned Australia is hurtling towards a US-style system of vertically integrated managed care, where health funds have too much say over the clinical care that patients receive,” AMA president Dr Danielle McMullen said.
“It is crucial that we avoid a scenario where profits are put before patients, like we have seen happen in the US with disastrous results.
“Clinical decisions must remain in the hands of doctors and their patients – not influenced by insurers or corporate ownership – so that care is guided by need, not by financial incentives.”
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Dr McMullen said she was particularly concerned at the conflict of interest inherent in an insurer both funding and delivering care, and that patients should be concerned at the prospect of insurers accessing more of their health information than ever before.
A Bupa spokesman told The Medical Republic that it was not interested in seeing the laws that prohibit it from funding the majority of primary care changed or removed.
“We comply with all Australian Private Health Insurance laws which prohibit the ‘US-style managed care’ that is the topic of some commentary,” they said.
“We have to remember it’s not even allowed in Australia, and no one is proposing to change those laws.”
The spokesman said that Bupa supports full clinical autonomy, and that “preserving the autonomy of healthcare providers and allowing them to make independent decisions is fundamentally important to deliver the best health outcomes for a patient”.
