While private health and GP interests may seem to align in some areas, one should always be careful what they wish for.
Over the last few years, private health insurers like Bupa and Medibank have been quietly buying up general practices, despite being barred from meaningfully funding most aspects of primary care.
It’s got some hackles up.
In a lively session at the RACGP’s annual conference on Saturday, Newcastle GP Dr Max Mollenkopf and RACGP NSW and ACT chair Dr Rebekah Hoffman – both of whom are practice owners – went head-to-head with Dr Simon Benson, clinical director for connected care at health insurer Bupa.
“Bupa can’t fund traditional Medicare practice services, and yet, you guys are also accumulating medical centres in the background. And then there’s obviously other providers picking up large groups [of GP practices],” Dr Mollenkopf said.
“I mean, it’s like collecting cars without having a licence.
“Is there ultimately a hope that something will change in the future, so you guys can start doing more of [the provision of care]?
“Why do all these insurers want to own all these practices? I don’t think my business is so good that it should get swooped up by the private health insurance.”
Dr Benson, who is also a practising GP, said that Bupa had recognised that there was a need for change in the way healthcare is funded moving forward.
“For Bupa, the way to do that is to invest in the primary care system by investing in and acquiring clinics,” he said.
“But these clinics are not just for our members. These clinics are for everybody, but [we] can start to offer some primary and preventative services in that environment.”
While private health insurers cannot fund primary care services which are already covered by Medicare, they can fund services which are Medicare-ineligible.
Bupa, for instance, funds its members to receive three free telehealth consults per year with a provider they have never met face-to-face.
Dr Benson told GP25 delegates that Bupa’s online doctor service provided roughly 200,000 consults per year.
“As I was working on setting that [service] up, one of the key questions was around continuity of care infraction … We put in a lot of effort into thinking about how we advertise and promote the service to [communicate that] this is convenience, this is accessibility, this is not for long term care,” Dr Benson said.
“We put in a three-consultation limit for each person, so that that’s all they get, and that’s a signal to say, ‘this is not your GP, this is when your GP is unavailable and you need something quickly’.
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“The other thing we did was ensure, right from the get-go, that we were integrated with the My Health Record.
“And for all its faults, it is the system that is meant to be, … so event summaries are always uploaded, with patient consent.”
Dr Hoffman questioned whether this went far enough to mitigate fragmentation of care.
“I’m just going to say that I think we can do better than ‘with consent, we can upload to My Health Record’,” she said.
“I think that, out of respect for GPs, actually ensuring that communication goes back to that [patient’s] regular GP at every visit … would be the absolute minimum that we would expect.”
Car collector comment notwithstanding, Dr Mollenkopf insisted that he was by no means a private insurance “hater”.
“When I look at my patient in front of me, I say, ‘well, you’re fat and you’ve got arthritis, and we probably need to address one of those things to help to stop the other one from progressing to a knee replacement’,” he said.
“At the same time, there’s probably an insurer out there who’s saying, ‘you’re fat, you need knee replacements’ – and while I would like them to lose weight to avoid the knee replacement for health reasons, the [insurer] would like them to do it because they don’t really want to pay for a knee replacement.
“We have a common goal, and in those spaces I would love to see more partnership and more funding available.”
Dr Walid Jammal, a prominent GP and health system reform advocate, chimed in with a word of caution for Dr Mollenkopf.
“My message to you and my colleagues in this room is: be very careful what you wish for,” Dr Jammal said.
“Be very, very careful. There is a role [for private health, and] that is not covering the rebate, ever.
“I will advocate with my whole being to never allow that to happen.”
The RACGP’s annual conference, GP25, was held at the Brisbane Convention and Exhibition Centre from 14 to 16 November.
