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THE coronavirus disease 2019 (COVID-19) pandemic brings about an unprecedented time of uncertainty. While the direct morbidity and mortality of the virus is unquestionable, the ongoing psychological impacts on health care workers and the community will likely be significant, but their scope is yet to be appreciated.
We do not know how long our public health and frontline health care staff will be facing the virus. We do not know how long our educational institutions and workplaces will be affected. We do not know how long we will have to socially isolate, away from support systems such as friends, co-workers and family. There are just so many unknowns facing Australian health care staff at present.
Health care workers are indisputably heroes. Every day around the globe, they are putting themselves at significant risk of work-related infection and psychological trauma during this crisis. Recognising this, there has been a huge outpouring of community support for Australian health care workers. The community has rallied, and Facebook community pages such as Adopt a Healthcare Worker offer kind-hearted gestures of the most simple things to make lives easier. Meals, groceries, child-minding, even offers of accommodation for health care workers with sick or elderly people at home. Private companies have also rallied. Even if it’s just coffee, those simple gestures are appreciated.
But there will be tragedies. There has been a COVID-19-related death in a health care worker in Australia and this weighs heavily on those in frontline work. Health care workers in Italy, the US, China, the UK, France, Spain and Iran have lost their lives to this virus. In Italy, at the time of writing, 100 doctors have died of COVID-19. Every country has a different battle to face, and we have fought to prevent our situation becoming as dire as what we see across the world and we are making valid progress. Despite this, we know that Australian health care workers have faced hardships and distress as a result of this pandemic.
Even before COVID-19, Australian doctors have seen exclusions, or exorbitant premiums, on their income protection and health insurance policies from seeking help for their mental health. While we would argue that this is unacceptable at any time, it becomes particularly pertinent when considered during this pandemic. Although the true extent on the impacts on Australian health care workers is not yet known, it should be expected that we will see a spike in mental health problems in this population. The World Health Organization recognised this and in their statement on Mental health and psychosocial considerations during the COVID-19 outbreak specifically outlined the increased risk placed on health care workers.
An amnesty on insurance practices that decrease help-seeking behaviour is urgently needed for any consultations with psychologists, GPs and psychiatrists when related to issues arising from their work during COVID-19. Issues and consequences of hardship and illness that increase the need for mental health support should not have an impact on the cost of future income protection or other relevant insurance in the future. This is particularly true for our doctors at the beginning of their career, interns and residents who may not have established coverage.
In this time of immense uncertainty, it would be unconscionable for insurers to use mental health issues arising from COVID-19 as a way to increase premiums or loading on health insurance or income protection for health care workers in the coming years.
Dr Emily Shao is an executive member of the Australian Medical Association Queensland Council of Doctors in Training. She is currently a PhD candidate at the University of Queensland.
Dr Rhys Thomas is an executive member of the Doctors’ Health Advisory Service Queensland. He is a Psychiatry registrar at the Royal Brisbane and Women’s Hospital.
Dr Kate Engelke is Company Secretary of Queensland Doctors’ Health Program. She is currently working as a General Surgery Principal House Officer at Townsville Hospital and is a Lecturer with James Cook University.
Dr Margaret Kay is a Senior Lecturer at UQ and is a GP in Brisbane. She is the Medical Director of the Queensland Doctors’ Health Program.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
As an Income Protection adviser of over 15 years acting almost exclusively for doctors, I really care about the points raised in the statement above.
Healthcare workers serve our community and ordinarily face tremendous physical and psychological challenges; especially when a pandemic falls upon us such as we face today.
I also appreciate the irony that one who seeks treatment (be they a medico or not) is often met with higher premiums or harsher policy terms from insurers who put them in a riskier category than otherwise equivalent people. That in terms creates negative health outcomes for people who may put off medical help in order to get a better outcome for themselves on their insurances.
The above statement seems to suggest that there will be a significant impact of the current crisis on doctors’ mental health which I agree is highly likely (if not already manifest). By extension, people will lean on insurers for increased payouts around mental-health related disability claims.
The statement says that doctors should not have to pay more or suffer harsher policy terms which may be fair given the unique role doctors play in our wider community.
But who ought to pick up the tab? Should the burden be carried by non-medical workers who have policies? Should it flow on to the shareholders behind the life insurers in the form of lower profits or increased losses? Or should the government prop up insurers in terms of this very hard to quantify impact.
Or should individuals continue to be assessed on a case by case basis as prone to over-simplification this process is?
Who cares for the Carrer? The answer is of course we the carers. Covid-19 has shown how dangerous it is physically and mentally to be a doctor. The general public is also acutely aware of this fact and it is prime time to utilize this seldom found awareness through collective demands for improving doctors (and other healthcare workers) lives.
The greatest risk will soon be that this covid-19 pandemic blows over without effecting real change and that the economists with their excel spreadsheets (safely working from home through the epidemic I hasten to add) restart the control of the tone of the aims and values of the healthcare system (ie focus on cutting costs (ie Health Care Workers remuneration/fees, saving on protective equipment, reducing adequate treatment capacity in times of surge demand ie remove ‘Slack’ from the system), demand more production from the system, until the system almost breaks, then ease slightly off, wait a while, then repeat…
If higher premiums are a sad fact of life when seeking help then medical providers collectively need to incorporate this fact prospectively into their pricing ie factor it in and pass it on to their patients via Medicare or hospital employer.
A good start would be that all Medicare providers received free coverage for these treatments as long as they were a GP and for a period (5-10 years) after ceasing activity as a GP. Medicare would then have an financial interest in their GPs not getting stressed or sick.
Those employed by hospitals should receive free insurance policies to cover the need for such services as part of their basic remuneration. These policies also should likewise cover a period after cessation of hospital employment (5-19years) in the event an adverse reaction results in an affected doctor resigning from their position because of their mental (or physical) hardships.
We as doctors need to stand together and demand that we are cared for properly. There is no better time than now politically to make our needs known to the public and improve our situation so we can do our job to our fullest and our safest.
It may be unconscionable, but it’s mandatory.
Insurers are required to assess risk and load premiums accordingly, otherwise they could unfairly discriminate: “John Smith’s a good friend, he can have a discount” or “Mary Jones is a One Nation member, we’ll charge her extra.”
They are exempt from most anti-discrimination laws, e.g. they can charge a man more than a woman, based on life expectancy, and a young male driver more than a young female, based on accident statistics.
They simply have to justify their actuarial assessment, if challenged by the relevant regulatory body e.g. Insurance Council.
All doctors discriminate on mental health grounds (legally). If a patient says they are going to go home and take their asthma medication, we smile approvingly, if they say they are going to go home and kill their wife and kids, then shoot themselves, we have them locked up. Yes, even though that may deter help-seeking behaviour.
Essentially, there are 3 categories of doctors:
1. Those who have known / treated mental health issues.
2. Those who have unknown / untreated mental health issues.
3. Those who have no mental health issues.
Category 3 are the lowest risk, Cat 1 are actuarially higher risk, Cat 2 may be intermediate or perhaps higher than Cat 1, but are not self-identified on an insurance questionnaire. NASA or the Australian Antarctic Division could test for Cat 2, but it is prohibitive for insurers.
Therefore the insurer rates Cat 1 higher risk than the combined 2&3 pool.
We treat our patients according to their risk, and should expect insurance companies to do the same.
As a sideline, I’m not sure about Queensland, but in NSW I pay a higher annual medical indemnity insurance than all four authors put together, if they were NSW DITs/GPs. That’s not because I’m inherently more negligent than all four, but actuarially, surgeons are sued more often, with higher quantum, than DITs or GPs. Is this a case of “exorbitant premiums”, or simply prudent actuarial policy? Like the authors, i’d love to pay the same professional indemnity and life insurance premiums as a 25 yr old public servant, but that’s not how insurance works.