AMA national president Dr Michael Gannon needs to "get real" about transparency of specialist fees and consumer feedback, according to managing director of Bupa Health Insurance, Dr Dwayne Crombie.
Dr Crombie spoke to Bupa Media following Dr Gannon's recent address to the National Press Club during which he questioned the benefits of transparency, in fees and feedback, and criticised health insurers for maintaining policies with exclusions. He also claimed insurers were seeking to exert too much control over clinical decision making.
However, according to Dr Crombie, the very clear principle enshrined in regulations governing private health insurance is doctors determine treatment.
"I don't know that any insurer is trying to stop doctors being the key driver of clinical treatment in this country," he said. “I think it's right that doctors drive a lot of cost. Often, they don’t practice the way they should practice in their own medical evidence and literature. I think it’s reasonable, particularly for the public and for government, and for any organisation, to question whether they are actually providing good quality, effective medicine all of the time."
On transparency and consumer feedback, Dr Crombie said Dr Gannon appears to be "putting his head in the sand."
He continued, "I mean every profession, every service in the 21st century has to account to consumers. I think the idea that doctors should have their fees transparent and people will be able to make comments about whether they are getting good service, what the facilities are like, whether they're waiting too long; that's completely what you’d expect.
"But I think Michael Gannon and the AMA need to get real. Consumers will give feedback, they’re giving feedback now in a completely unmoderated fashion so it's time to listen to the feedback not try and pretend that you’re immune from it."
Dr Crombie also questioned Dr Gannon's claim 88 per cent of all specialist services are gap free.
"That's absolutely true. But those are the overall figures, they include all of the smaller operations like gastroscopy, colonoscopy, they include anaesthetists’ fees - and they are actually remarkably good at not charging big payments," he said.
"If you want to look below the general figures, if you want to look at the surgical fee for a cataract, hip operation or removal of prostate, what we're finding is that between 20 and 40% of the surgeons’ fees in those specific operations are over $500, in some cases over $5000."