Private health GPs – faster service or two-tiered US-style health system?

Transcript

CHRIS UHLMANN, PRESENTER: Queensland is incubating an idea that could radically change Australia’s health system. Private insurers are moving into general practice, saying it will help keep their customers healthy and that will cut hospital costs.

Medibank Private is paying the office expenses for some doctors to guarantee same-day treatment for its members, with no out-of-pocket costs.

But critics warn it heralds a two-tiered American-style health system and moves are afoot to ban the trial.

Political correspondent Sabra Lane reports.

SABRA LANE, REPORTER: In Queensland right now at selected GP clinics, a quiet revolution’s underway that could change the way primary health care is delivered across Australia.

Supporters say it’s the way of the future. Critics warn it heralds a two-tiered health system, soaring private health insurance premiums and the end of Medicare as we know it.

ANDREW WILSON, MEDIBANK PRIVATE: That’s the sector that keeps our members healthy. When they’re sick, when they need care, when they need care when they’ve got chronic conditions, that’s where they need to go. So it’s vitally important for us that we get better access for our members in primary care if we can.

RICHARD DI NATALE, GREENS HEALTH SPOKESPERSON: Well the company says that as a result of having private health insurance cover, you’ll get access to a doctor faster. Now that can only mean that if you don’t have private health insurance cover, you won’t get the same level of access to a GP and that’s just not a fair system.

SABRA LANE: At 26 medical centres across Brisbane, Cairns and the Gold Coast, Medibank Private is pushing into the realm of GP surgeries. The company’s promising its policy holders a same-day appointment with a GP if patients call before 10 in the morning during the week and within 24 hours if they call after that time. The offer of fee-free consultations, including after-hours appointments with participating GP clinics, many owned by IPN. And after-hours GP visits within three hours of calling for an appointment. At last count, 30,000 consultations had been conducted under the trial. Medibank says, ideally, it would like to eventually roll out the scheme across the nation.

ANDREW WILSON: We believe the GP access scheme will ultimately lead to lower premiums. The real cost in healthcare for us and for other payers is downstream. It’s the result of people who don’t get the care they need when they need it, who have chronic diseases that are not well-managed. So by improving access and care provided in a primary care setting, we think that can have a significant downstream effect.

SABRA LANE: Dr Brian Morton’s been a family GP for more than 30 years. He’s the AMA’s spokesman on general practice and is worried about the ramifications of the Medibank Private trial.

BRIAN MORTON, AUSTRALIAN MEDICAL ASSOCIATION: The organisation in the practice should always be for urgent cases with a medical need get priority, not because you’re a member of a health fund and you want a script filled or a vaccination for an overseas holiday; it should be on medical need and the urgency and the access should be based on medical need.

SABRA LANE: Laws currently ban private health insurers from paying for out-of-hospital costs that are covered by Medicare, like visits to the family doctor. Medibank Private says the scheme’s operating within the law, that it’s helping to contribute only to administrative costs of the clinics participating in it. Traditionally, insurers get involved in their customers care when they’re chronically ill and already in hospital. The company says the trial’s aimed at prevention and stopping patients from needing expensive treatment.

Other private health companies are testing pilot programs with GP clinics too.

DWAYNE CROMBIE, BUPA: It’s almost strange that we have millions of members that we couldn’t try and help our members by working with general practice and primary care. It just seems slightly odd to me that you wouldn’t try and involve us in that process. I mean, we don’t want to take over the world, but, you know, we get alot of feedback from our members who say, “Can’t you help us a bit more, as we struggle through this current system?”

SABRA LANE: Greens Senator Richard Di Natale, a GP before he entered Parliament, is a fierce critic of Medibank’s GP trial, arguing that insured patients will get preferential treatment ahead of those who don’t have cover.

RICHARD DI NATALE: We’ll see people’s health insurance premiums skyrocket, and secondly, if you look forward, what this is going to do is take us head first to a two-tiered US-style health system where you get one level of healthcare if you’ve got private health insurance and you get second-rate healthcare if you don’t and that’s not a path we want to be on.

STEPHEN LEEDER, UNIVERSITY OF SYDNEY: A lot of very prejudicial things are said about managed care, largely by people who’ve got no idea what it is. And it’s sort of waved like a shroud, “Oh, we’re going to get managed care.” But, at its best, as you see it done in the United States, it’s very effective, both in terms of cost and patient outcomes, that deserves serious thought.

SABRA LANE: The Health Minister Peter Dutton’s previously voiced philosophical support for more private sector involvement in primary care.

PETER DUTTON, HEALTH MINISTER (February): Why shouldn’t we be open to greater involvement of the insurers who cover 11 million Australians, to keep those people healthy and getting more regular access to primary care?

SABRA LANE: The Opposition says it has deep reservations about the trial. The Greens want it stopped. Senator Di Natale has drafted a bill targeting the Medibank trial.

RICHARD DI NATALE: The bill is designed to stop this trial dead in its tracks.

SABRA LANE: Today in Sydney, a parliamentary committee pressed the company for answers about the controversial trial.

DAN O’BRIEN, MEDIBANK PRIVATE: Keeping people out of hospital is the most important aspect to keeping health care affordable.

SABRA LANE: Executives were asked if the pilot program was part of the company’s plan to boost its value ahead of its privatisation.

DAN O’BRIEN: Absolutely not. It’s got absolutely nothing to do with pending ownership changes at all. This is about reducing benefit outlays.

SABRA LANE: The AMA’s president is sceptical of a national rollout.

BRIAN OWLER, AMA: If you have a very busy practice and you actually have more patients than you can deal with or you have multiple insurers engaging in the same arrangement, what you’ll end up with is a situation where you have to have private health insurance to be able to get that appointment.

SABRA LANE: Medibank’s rolling out a separate trial in Victoria and Western Australia aimed at the chronically ill. The company’s teamed up with doctors and state governments to better co-ordinate information and care. It will include non-insured patients.

Public Health Professor Stephen Leeder believes that trial’s worthwhile, but he’s not a fan of the Queensland experiment.

STEPHEN LEEDER: The Medibank Private trials in Victoria and Western Australia of integrated care, I have a completely different feeling about. I think they’re perfectly legitimate experiments. The results could be interesting and informative and helpful from the point of view of providing care for people with chronic problems in Australia.

CHRIS UHLMANN: Sabra lane reporting. And the Health Minister Peter Dutton had intended to be on the program this evening, but couldn’t make it. Hopefully, we’ll speak to him soon.