Doctors, minister and funds want private insurers to cover GP care

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HEALTH fund premiums will rise if insurers are allowed to cover GP care, says the chief of one of the nation’s largest insurers. 

However NIB chief Mark Fitzgibbon says the change being examined by Health Minister Peter Dutton is one the country must make if we are to afford healthcare in the next three decades.

The Australian Medical Association yesterday backed the idea of working with private insurers in an official position statement.

“The AMA believes it is time for the Government, Private Health Insurers (PHIs) and the medical profession to look at models that would support a greater role for GPs in caring for privately insured patients,” AMA president Dr Steve Hambelton said yesterday.

Health Minister Peter Dutton earlier this year floated the idea of a greater role for insurers in primary care and insurers are hoping it is included in the May budget.

“I welcome the AMA position paper and look forward to working with the AMA, doctors and insurers to find ways to keep people healthy and provide them with health services,” Mr Dutton said yesterday.

Medibank Private is already trialling a scheme in Queensland where it covers GP gap payments of 4500 of its members.

This program is now being extended to 30 new medical centres.

Medibank managing director George Saviddes says his fund wants to pay to coordinate the GP care of the sickest three per cent of its members.

“Our research shows that high-need patients would like a program or organisation that could help them ‘join the dots’ and provide them with a holistic understanding of their health,” he said.

Mark Fitzgibbon told News Corp Australia NIB wants to pay GPs to provide diabetes and other chronic disease management plans.

The fund is also looking at paying for nurses in doctors surgeries who would contact sick patients every day to ensure they stayed out of hospital.

A plan that might see the fund work with a doctor to keep frequent flyer patients out of hospital is also being examined.

“We would say to Dr Mary you have 50 NIB members in your practice who cost us $50,000 each year, if you can reduce that cost we’ll split the savings with you,” he said.

Doctors could also be paid by insurers to provide home visits, he said.

“Inevitably it means paying higher premiums,” he said.

“But it means paying less tax because you are easing the pressure on government expenditure.

“This is taking us down the road of shifting the costs away from the government, from the system to private individuals,” he said.

If Mr Dutton goes ahead with a plan to means test access to bulk billing, health funds could step in to fill the gap and cover the cost of a doctor’s visit for wealthier Australians, Mr Fitzgibbon said.

Health funds want to pay for GP care to save money by keeping people with chronic illness out of hospital but there are concerns it could lead to a two tier health system.

The health department has previously raised concerns any such scheme could blow out the cost of the 30 per cent private health fund rebate as premiums rose to cover the extra cost of GP visits.

With health insurers likely to pay doctors more than Medicare it could place pressure on the Medicare rebate, which has been raised by less than the inflation rate for decades and this could blow a hole in the health budget.