AMA President Dr Michael Gannon has demanded a ‘please explain’ after private health insurer Bupa told a third of its Australian customers their cover for a range of procedures will change from a minimal benefit to total exclusion. 

These procedures include knee replacements, pregnancy and renal dialysis.

Bupa made the announcement via letter late in February and suggested to medical practices that: “Prior to the commencement of any treatment, patients should be encouraged to contact Bupa directly to confirm their cover entitlements, and any possible out of pocket expenses that may be applicable.”

Bupa’s Head of Medical Benefits Andrew Ashcroft also wrote: “Customers affected by these changes will be given an opportunity to upgrade their cover should they wish to receive full coverage for services that were previously only restricted cover.”

The punitive changes were announced just weeks after Federal Health Minister Greg Hunt approved a 3.95 per cent increase to private health insurance premiums.

Dr Gannon told the Minister that the Government should now urgently seek advice from the Health Department and the Private Health Insurance Ombudsman as to the legality of Bupa’s actions. 

“The fact that the change has occurred straight after a premium increase, straight after agreement was made to retain second tier rates for non-contracted facilities, and straight after an announcement by Government to work collaboratively with the sector on the issue of out-of-pocket costs, is unconscionable,” Dr Gannon said.

“The AMA will not stand by and let Bupa, or any insurer, take this big leap towards US-style managed care.

“The care that Australian patients receive will not be dictated by a big multinational with a plan for vertical integration.”

Dr Gannon said customers were right to be concerned with the new list of exclusions, but that there was even more bad news hidden in the fine print of Bupa’s new business plan.

“From 1 August 2018, no-gap and known-gap rates will now only be paid to the practitioner if the facility in which the procedure takes place also has an agreement with Bupa,” he said.

“Medical benefit rates outside those facilities will now only be paid at the minimum rate that the insurers are required to pay – that is, 25 per cent of the MBS.”

Dr Gannon has written to all AMA members to explain the changes and why they are bad for patients and the medical profession (the full letter can be viewed at ausmed/bupa-decision-bad-news-patients-and-profession).

 “They are bad for the reputation of private health insurance. They are bad news for the contribution that the private system makes to the Australian health care system,” he said.

During a media interview on the subject, Dr Gannon said private health insurance policy holders should start asking questions about whether or not their policies are fit for purpose.

“If it does nothing more than give you treatment in a public hospital, how is that better than relying on the public system?” he said

“If it does nothing more than give you a whole list of exclusions where you can’t access care when you’re sick, when you’re scared, that’s not worth it.

“So, what we’re saying is there needs to be more focus on the value in the policies. We’re worried about the changes in the industry, we’re worried about the junk policies throughout there.

“We do have a Private Health Insurance Ombudsman, and when you look at the complaints there, you get a real feel for the problem. We see a lot of talk in the media about out-of-pocket expenses being the real problem with the value proposition. If you look at the Ombudsman’s report, that’s not the problem.

“Nearly 90 per cent of operations are provided by doctors at no-gap; another five or six per cent at known gap of less than $500.

“We don’t think we’re the problem, but when we see unilateral action like we’ve seen from big insurers like Bupa to say what they won’t be covering, we encourage individual policyholders to ring up, ask, and make sure they’re covered if and when they get sick.”

CHRIS JOHNSON

Every child in Australia deserves to grow up in a home free from harm. Yet year in, year out, we see an increase in the numbers of substantiated child abuse and neglect cases. In 2016-17, nearly 50, 000 children were found to have been – or were at risk of being – abused, neglected or otherwise harmed. This is unacceptable.

As medical professionals, we are at the forefront of responding to and treating the consequences of child abuse. Doctors see firsthand how the physical and psychological scars of maltreatment and neglect have lifelong negative effects on children and those who love them. They know that the best possible medicine is to stop this trauma occurring in the first place.

The AMA has long advocated for a public health approach to child protection. Just as we know it is a mistake to position the ambulance at the bottom of the cliff, we know we simply can’t wait until problems within families are so severe that the only option is to take children away.

Over the last 20 years, there have been more than 40 inquiries and commissions into the failings of the child protections system. Adopting the principles of a public health model and investing in early intervention and prevention has been a recurring recommendation and repeatedly called for by those of us committed to improving the wellbeing and safety of children.

Many governments have increasingly adopted public health based polices in relation to child protection, as evidenced by the state and federal collaboration on the National Framework for Protecting Australia’s Children – a national policy premised on a public health model.

Yet in many ways, the mantra that prevention is better than the cure has failed to translate from political rhetoric into meaningful change. This is most clearly seen in budget breakdowns. Significant and sustained funding for prevention and early intervention has yet to become embedded in Federal and State budgets.

Australian service systems continue to remain reactive rather than preventive, with only 16.6 per cent of total child protection expenditure nationally invested in early intervention and prevention.

Nationally in 2015-16, $2.7 billion was spent on out-of-home-care (accounting for 57.4 per cent of all expenditure on child protection services). This amount has continually increased over the last five years.

If we want to see fewer children coming through our hospital doors with injuries no child should experience, we need to stop tinkering at the edges of a broken system. Significant transformation is needed to get families the help they need, quickly and early on, to prevent the worst from happening. To this end, the AMA has been following the development of an ambitious new advocacy campaign to address the persistent barriers to change.

This campaign, initiated by The Benevolent Society in partnership with more than 20 organisations across a range of sectors, aims to put the wellbeing and safety of children on the public and political agenda. The campaign will be calling for greater Government accountability for improved child wellbeing outcomes and will advocate for adequate funding to ensure that families getting the right support at the right time.

While this campaign is still in its early phases – with a public launch forecast for later this year – the AMA is keeping a close eye on its development and providing input into the campaign objectives.

SIMON TATZ
AMA DIRECTOR, PUBLIC HEALTH