Medical indemnifier Avant says DoHDA’s quest to fix the ‘mostly voluntary’ informed financial consent system is misguided.
The Department of Health, Disability and Ageing is currently attempting to fix what it sees as “limited” consumer protections and “mostly voluntary” compliance standards for informed financial consent in the medical sector.
Which would all be well and good, if not for the slightly awkward fact that informed financial consent (IFC) is already underpinned by legal obligations rooted in contract law.
Avant Mutual, one of Australia’s largest medical indemnity organisations, pointed this out in a new submission to the department’s ongoing consultation on the matter.
“The [DoHDA] consultation paper refers to IFC as an ‘ethical and professional standard’ with ‘limited regulatory oversight and remedies for patients’,” the submission read.
“It characterises existing IFC frameworks as requiring ‘mostly voluntary’ compliance only. This is incorrect and risks creating confusion and uncertainty for both practitioners and patients.
“IFC is a mandatory legal obligation based primarily in contract law: the practitioner agrees to provide the patient with healthcare services in exchange for payment (be it direct from the patient, through Medicare or private health insurance and/or other means).
“Patients must be informed of costs in advance, and a healthcare provider will not be able to receive payment for additional out of pocket costs from a patient where there was no prior agreement.”
What’s more, Avant argued, the consultation paper understates the role of the Medical Board of Australia’s code of conduct.
The code of conduct, which doctors must agree to as part of their registration, obliges doctors to inform patients of fees and charges in a timely way.
“The Code of Conduct mandates compliance and is used to evaluate a doctor’s professional conduct. Failure to meet these standards can have serious and ongoing consequences for a doctor’s registration, including conditions, suspension or cancellation,” Avant wrote.
While DoHDA’s consultation paper does mention the code, it refers to it as a “principles-based requirement” and notes that it does not specify the format, medium, or documentation of cost disclosure.
Like the AMA and RACGP before it, Avant was against all of the reform options which involved introducing a new regulatory body or expanding the regulatory powers of an existing organisation like the PSR or the ACCC.
Related
Adding a new regulator or adding another layer to the existing regulatory landscape, the medical indemnifier said, only risks compounding the existing issue and further complicating Australia’s regulatory landscape.
“In practice, patients unhappy with the IFC process often have other concerns with the clinical care they received,” Avant said.
“If a new regulator were established, these patients would need to complain to two separate bodies, and an additional process would need to be built-in to ensure IFC-related issues are not accepted or considered by existing regulators.
“The patients who are most disadvantaged by the current system – such as those with lower health or financial literacy, those in regional and remote areas, those from culturally diverse backgrounds – would be further disadvantaged by having to navigate yet another complaints pathway.”
The only reform option Avant did not directly oppose was the final one, under which there would be no legal change and DoHDA would instead focus on education and guidance.
Specifically, Avant called for a joint statement from AHPRA and the national boards covering IFC obligations in detail, alongside an education campaign for practitioners and the public.
This approach, it said, would leave room for nuance in how IFC was delivered.
“The conversation a surgeon has with a patient before a complex, elective, multi-provider procedure is fundamentally different from the conversation a general practitioner has about treatment costs during a routine consultation,” Avant wrote.
“The information that needs to be conveyed, level of detail, format, and timing all vary because a patient-centred approach requires flexibility.”
As a final note, Avant cautioned DoHDA on moving to amend IFC obligations before the separate Medical Costs Finder transparency changes were implemented.
