Featured Health Reform

Is Australia’s Healthcare System Being Americanised?

PulseLine looks at the recent decision by private health insurance company Bupa to plan changes to its Medical Gap Scheme and the swift response from the Australian Medical Association.

In a letter dated 23 February Bupa informed doctors that from August insured patients would only qualify for gap cover if they were treated at a Bupa-contracted hospital or day-stay facility, causing the Australian Medical Association (AMA) to warn of “US-style managed care” and policyholders to leave.

Last week the AMA Federal Council passed two motions against private health insurer Bupa over plans to change to its policies and coverage.

Dr Dwayne Crombie, Managing Director of Bupa Health Insurance, said he always supported maintaining the Medical Gap Scheme, as long as Bupa could confirm the hospital admission really was a pre-booked private admission.

“We’ve always recognised that a patient should be able to make the choice to receive a private experience in a public hospital, and in fact a public hospital may be the best setting to do so. So, we support patients and doctors and we believe that making sure any Bupa customer receives the private experience they are being billed for, is a good thing for all involved.

“When a patient is admitted to a public hospital as an emergency or acute patient and treated as a public patient, they should use Medicare to fund that treatment as it is designed to do so,” Dr Crombie said.

AMA President Dr Michael Gannon described the announcement as a big leap towards US-style managed care and he demanded a ‘please explain’.

“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.”

Bupa has and will continue to work to remove (or reduce) out-of-pocket costs for its customers, while at the same time tackling unnecessary waste in the system which is one of the many factors driving up private health insurance premiums.

If you’d like to watch Dr Dwayne Crombie response:

It will be interesting to see if the Government’s forthcoming private health reforms deliver the much-needed transparency for consumers regarding the myriad of confusing private health insurance products and transparency around out of pocket costs associated with doctors services and private hospitals.

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