Health insurers to work directly with doctors under historic deal

By medical reporter Sophie Scott

Private health insurers are set to work directly with GPs and hospitals in an historic agreement designed to help improve Australia’s health system.

The agreement comes after Federal Health Minister Sussan Ley announced the winners of the 28 new “primary health networks” on the weekend.

They will receive up to $900 million in Government funds.

It is the first time private health insurers will be involved in running programs that aim to keep patients healthy.

A spokesman for the peak body for insurers Private Health Care Australia said the best way to improve Australia’s health system is to increase the role it plays in GP care.

He said the body is watching closely to see how primary health networks can increase linkages between insurers and primary care.

“We see increased involvement by private health insurance in primary care as the key to improving the health system,” he said.

Ms Ley said the networks – which replace Medicare Locals – will improve frontline services for patients and provide better coordination between hospitals and GPs.

As the ABC foreshadowed, four out of 28 primary health networks have a private health insurer as part of the winning bid.

South-eastern NSW has partnered with Peoplecare, a national member-owned, not-for-profit health fund.

In Victoria, Grampians and Barwon south-west partnered with GMHBA, a private health insurer.

In Brisbane, HCF and Bupa have partnered with Brisbane North while in the west, Perth North/Perth South/country WA partnered with HCF and Bupa.

In some cases, the networks will be run by consortiums that include universities and hospitals.

The partnership could create conflicts of interest: expert

But there are fears that allowing private health insurers to run training and workplace programs for GPs will create conflicts of interest.

Associate Professor Gawaine Powell Davies, a health care expert from the University of New South Wales, is concerned insurers could use their role in training and coordinating GP clinics to influence referral practices.

“My guess is there will be a lot of little slippery slopes and a lot of little back doors that a year or two down the track lead to private health insurance taking a bigger role,” he said.

“Which is not necessarily good for the community as a whole.

“Their major commitment has to be to their members.

“However well intentioned they are to the rest of the community, primary health networks really have to have an eye first on those who have the least good health care and are least likely to be in private health insurance.”

That’s not a view shared by Andrew Podger, Professor of Public Policy at Australian National University in Canberra.

Professor Podger said having private health insurance companies involved in GP care could be beneficial.

“Of course, you need to manage any conflicts of interest in case they are trying to favour their members interests, but it is manageable,” he said.

“Private health insurers need to protect the good health of their members.”

AMA fears uninsured people may miss out of services

The Australian Medical Association has raised concerns about the appropriateness of private health insurers in primary care.

AMA spokesman Dr Brian Morton said involving private health companies in GP care means the uninsured may lose out.

“The conflict of interest for a private health insurer may be they provide better access to their members,” Dr Morton said.

“It may be preferential access to services, rather than making it equitable in [terms of] access for every Australian.”

But the AMA in Queensland has actually teamed up with HCF and Bupa to run the Brisbane North primary health network.

It will run the new program with the Metro North Hospital and Health service, Children’s health, Queensland Hospital and Health Service, Telstra Health and UnitingCare Health.

Federal Labor’s health spokeswoman Catherine King said she is concerned about private health insurance being involved in the new networks, calling it a deeply disturbing move.

“This allows private health insurers a direct say in the running of primary care and is the first step towards a two-tiered health system with health insurance members able to jump the queue,” she said.