Doctors not responsible for patient gaps

Jul 26 2005

Australian Medical Association (AMA) President, Dr Mukesh Haikerwal, said it was mischievous of the Australian Health Industry Association (AHIA) to be running around in the media this morning blaming doctors for private patients being confronted with high gap payments.

Dr Haikerwal said the AHIA’s position was a classic case of the industry ducking its responsibility to patients.

“Doctors charge fees and health funds create gaps,” Dr Haikerwal said.

“Doctors are responsible for fees and for delivering good quality care to patients in the private health sector and, where practicable, the doctor should inform the patient of fees payable in advance. This has been AMA policy since 1994.

“The Government and the health funds are responsible for gaps, and they have spent the last 20 years assiduously creating them and watching them grow.

“The Medicare Benefits Schedule (MBS) patient rebates have been so grossly neglected they have not kept up with CPI, let alone the real cost of providing high quality medical services. The Government must address this as a matter of urgency.

“The health funds, meanwhile, enjoy a $2.6 million taxpayer-funded subsidy and automatic annual premium increases without any compulsion to provide better products for patients.

“If the health funds want known gaps, they should all offer known gap products. HCF doesn't. MBF doesn't.

“Health Minister, Tony Abbott, should not approve any premium increase or any gap cover scheme for a health fund that does not make adequate provision for anaesthesia, pathology and radiology services.

“The Minister should not approve a scheme that he knows will force big anaesthesia gaps onto health fund members.

“The health funds and the Government between them have the power to remove gaps. Let them get on with it.

“If they want to discuss sensible gap cover schemes or educational strategies for improving informed financial consent (IFC) with the AMA and the medical profession, we will be pleased to do so.

“We have been asking them to do that for a long time, and it was raised openly at our private health Summit in March – and it will be raised again at the next meeting of medical specialist Colleges and Societies.

“The AMA has repeatedly asked the health funds to help us promote our informed financial consent forms, but they have refused.

“They are not interested in solutions: they are more interested in diverting attention from their own inadequate products and services.

“If the health funds want to raise punitive and draconian schemes to limit gap payments, they must bear and share the responsibility and impact.

“But first they must accept responsibility for gap payments in the first place.

“The health funds want to dictate where a patient service can be provided, when it can be provided, by whom it can be provided, and at what cost – which adds up to US-style managed care. We don’t want that in Australia.

“The AMA will fight for a patient’s right to excellence in health care. That is a doctor’s role.

“The Government has enormous powers over the health funds due to the 30 per cent subsidy it pays on premiums.

“It should use those powers to force the health funds to come up with gap cover schemes that offer proper cover for surgery – all aspects of surgery including anaesthesia, pathology and radiology.

“In exchange for taxpayer support, the health funds should do the right thing by taxpayers and offer them realistic rebates, known gaps, information to patients, and better choice of products,” Dr Haikerwal said.