The Australian Private Hospitals Association says a new report raises concerns over the risk of a move towards a US-style managed care health system.
The Australian Medical Association (AMA) report says Australia needs to avoid any push for insurers to pay for and provide health services.
The report has pointed to examples of insurers offering psychiatric patients out-of-hospital care without the involvement of the treating psychiatrist or general practitioner.
APHA CEO Michael Roff said private hospitals are willing and able to offer innovative programs for out-of-hospital care, but they are often only funded by one insurer, meaning not all patients have access to them.
“The AMA report suggests about 40 per cent of patients are missing out on access to these services, in large part because the funding models don’t support the innovation we know exists in the private hospital sector. It also highlights the danger that the vertical integration push is leading to outcomes that are not in patients’ best interests.
“There is also a genuine threat to clinical autonomy that could have further adverse consequences for patients,” he said.
Mr Roff said he welcomes AMA support for contestability into the market by introducing a minimum guaranteed payment scheme that ensures private health insurers pay for any out-of-hospital service chosen by the medical practitioner.
“APHA has long campaigned for a default benefit on out-of-hospital services. We agree that this is an important measure to allow private hospital patients to access services no matter who their insurer is. The APHA called for this change in its submission to the Government’s review of default benefits.
“It is quite obvious that if a private hospital is allowed to provide out-of-hospital services to patients following an episode of hospital care then continuity of care, quality of outcomes and patient satisfaction will improve. Unfortunately, some health insurance companies appear more focused on their own bottom line than meeting the needs of their members," said Mr Roff.