The peak body for private health insurers in Australia wants to see the Department of Health, Disability and Ageing look beyond the extreme outliers in specialist fee reform.
Private Healthcare Australia is calling on the government not to pull any punches when it comes to reining in out-of-pocket patient costs, beseeching it to “go further to address the broader rise … not just the extreme outliers”.
Last week, the Department of Health, Disability and Ageing released a consultation paper outlining six potential options to tackle extremely high non-GP specialist fees.
These ranged from greater transparency via the planned Medical Costs Finder updates to introducing a maximum allowable out-of-pocket fee attached to specific Medicare items.
While the paper did not settle on a single definition of an extreme fee, the proportion of doctors charging a fee which was three to five times the Medicare rebate was around 3.9% for in-hospital services and 1.8% for out-of-hospital services.
PHA CEO Dr Rachel David said the fee problem was “a bit broader than … a few bad apples”.
“One thing that we’ve become aware of is that in some specialties, it’s not just a small number of people that are that are causing concern – it’s actually been a specialty wide increase [in patient costs],” she told The Medical Republic.
Psychiatry and anaesthetics were two areas that Dr David considered fees across the board to be extremely high.
Although last week’s release was a consultation paper, movement on high out-of-pocket costs is already in motion; the inquiry into specialist fees is being conducted in tandem with an inquiry into informed financial consent for medical fees and the Medical Costs Finder is set to be overhauled next year.
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Dr David said the Medical Costs Finder changes would underpin any recommendations which were to arise from the specialist fees or informed financial consent consultations.
“I think that very important first step is [the] medical cost finder website and displaying the data on the website,” she said.
“Then, at least if GPs have access to that in their workflow and through their software, when a patient comes in who needs a referral, both the patient and the GP have a screen in front of them. They can have a look, see who’s in their area and what they’re likely to charge, and whether they’ve got waiting periods and so forth.
“And it makes it so much easier than putting the whole onus back on the consumer to shop around, when by the time they’re sitting in front of a specialist, they could have already outlaid $600 just for the privilege of speaking to [someone].”
If that were to have little effect, Dr David said her preference would be to “move away from carrots and toward sticks”.
“I think it’s important that some sort of peer review is introduced,” she said.
“The government’s [also] talked about sending [doctors] letters saying that they are in the 99th percentile of chargers. But if that doesn’t work, then administrative penalties, we think, should be the next stage.”
Potential penalties floated in the DoHDA consultation included fines and the removal of Medicare eligibility.
“This is my own personal view, but I think peer pressure can actually do a lot when it comes to medical practice,” Dr David said.
“Medicine is a really competitive area.
“Doctors have been taught to compete with one another from medical school onwards, and I think having an understanding about how you’re doing compared to your peers is an important part of this.”
Despite calling on the government not to shy away from cracking down on specialist fees, the PHA also encouraged it to ensure there were safeguards to prevent patients being “punished through the loss of their Medicare benefit”.
This was briefly mentioned in the consultation paper as a risk related to putting a firm cap on out-of-pocket fees.
