The Australian Medical Association (AMA) has urged the Federal Government to intervene in an insurance dispute that threatens to leave Calvary Health Care patients with hefty out-of-pocket fees.
Contract negotiations between Calvary Health Care and Medibank Private broke down earlier this month after five months of talks.
The private health insurer has been trying to negotiate a new contract with Calvary Health Care, which runs 15 public and private hospitals in the Australian Capital Territory, Tasmania and South Australia.
Medibank is refusing to fund 165 outcomes in hospital, including surgical complications, falls and bed sores.
The current contract expires at the end of the month.
Yesterday, AMA president Brian Owler said the dispute was partly the result of the Federal Government’s decision to privatise the health insurer.
Professor Owler’s statement came after the Tasmanian head of the AMA, Tim Greenaway, said on Tuesday that if a new agreement was not signed it would put undue pressure on public hospitals.
“This is a particular problem for the ACT, South Australia and Tasmania,” Professor Owler said.
“But this issue, if it is not stopped by this Government [and] by the minister, has the ability to threaten the balance between the public and private system right across the country.
“There are many patients that will be facing out of pocket expenses.
“This is going to put enormous strain on our hospital system, not just in terms of the private system but the public system as well.”
Professor Owler said he was concerned other insurers would follow Medibank’s lead.
“At the moment what we have is the fox in the hen house,” he said.
“As every farmer should know, the fox doesn’t just stop at one hen, it continues until they’re all gone.”
He said the Government could intervene in what was already “one of the most highly regulated sectors in the economy”.
“To say the Government doesn’t have a role in this dispute is ludicrous,” he said.
“It was this Government’s policy that put Medibank Private on the stock exchange, that created the biggest private health insurer where the responsibility was now the shareholders’ and concentrating on returns to investors.
“The Government also has about $6 billion of skin in the game.
“They pay for the private health insurance rebate, they support private health insurance and this move by Medibank Private continues to undermine it.”
‘Hospitals need to be more accountable for preventable events’
Medibank Private has defended its stance in negotiations with Calvary hospitals, saying it was trying to keep health care affordable.
Medibank spokesman Andrew Wilson said the insurer merely wanted Calvary hospitals to take responsibility for what he called “preventable events”.
“We’re really concerned to keep health care affordable and ensure the best possible outcomes for our members,” Mr Wilson told AM.
“Preventing unfortunate mistakes is part of that and the key thing is keeping premiums affordable; our members are telling us every day that premiums are becoming increasingly unaffordable.”
Mr Wilson said many hospitals had already agreed to Medibank’s terms.
“They’ve already agreed to these criteria,” he said.
“We are only interested in increasing the accountability of hospitals.
“We want to increase the ability of organisations like Medicare and hospitals to work together to reduce these events, and where events occur that are clearly not preventable then of course Medibank will be paying for those.”
AMA not acting in best interests of patients: healthcare advocate
Healthcare consumer advocate Russell McGowan said the AMA was not necessarily acting in the best interests of patients.
“The AMA will be very protective of the professional fees that their members charge,” he said.
“They’re concerned not about producing the highest quality of services, but protecting the interests of their members.
“I think doctors are used to saying, ‘we speak for our patients and we have our patients’ best interests at heart’, I’m not sure that is the case.”
Mr McGowan has also held a Medibank Private health insurance policy for 35 years.
He said he only held health insurance because of his wife’s healthcare needs.
“If it was just me I wouldn’t have private health insurance, because I think my needs, which are quite complex … can be met in the public system,” he said.
“I’m in a quandary … if I now choose to use Calvary Hospital for any private hospital services that my family might need, I’ll have to pay an additional out-of-pocket cost.
“The costs of private health insurance are now escalating, my premiums have gone up remarkably in the last few years, even though the number of people it’s covering has gone down, because my children are now not covered by my policy cause they’re over the age limit.”