The Australian Medical Association seemed more focussed on the interests of practitioners than on effectively addressing community concerns over the gap between health insurance rebates and the cost of services, the Australian Competition and Consumer Commission said today.
The ACCC forwarded its second report to the Senate* on anti-competitive or other practices by health funds or providers which reduce the extent of health cover for consumers. The report was tabled yesterday in the Senate.
"Health funds have continued to develop and expand contract-based no/known gap arrangements through a transaction-by-transaction Medical Purchaser Provider Agreement process. This allows practitioners the freedom to take part in no-gap arrangements on behalf of patients. The ACCC understands that 3000 medical practitioners are registered to use AXA's Ezyclaim while 2700 practitioners around Australia have agreements with the Australian Health Service Alliance member funds. The ACCC also notes that for the months of May and June 2000, 70 per cent of medical services provided to HCF members were at no gap to members.
"Funds have recently been allowed to set up no/known gap arrangements without the need for a negotiated agreement between funds and doctors. Although not in place during this reporting period, some funds have reported on their progress in developing such schemes. The Commission notes that Medibank Private's 'GapCover' scheme is the first scheme approved under the new legislation.
"Health funds have indicated differing views from the AMA over the capping of the medical gap, direct billing to funds, the principal doctor obtaining informed financial consent and the provision of information to fund members about participating doctors.
"The ACCC finds the AMA more focussed on practitioners' interests than on effectively addressing community concerns regarding the medical gap, specifically with regard to the capping of the medical gap by health funds and the provision of information enabling fund members to choose a doctor for whom they would not have to pay a gap..
"The ACCC acknowledges that gap cover schemes may provide a useful alternative to contract-based arrangements for some practitioners. However, aspects of the AMA-preferred model for the schemes appear at odds with the community objectives in these schemes.
"The ACCC has always had some difficulty with the AMA being involved in negotiations with health funds on these issues, and in particular on pricing and capping issues.
"Any threat of a boycott or of an attempt to induce a boycott by the AMA, or any other craft group, of schemes that do not meet its preferred model would be thoroughly investigated by the ACCC".
Professor Fels said the ACCC believed all doctors should provide financial information to patients and obtained informed financial consent so patients understood his/her financial obligation before agreeing to a service.
"For informed financial consent to be meaningful the lead practitioner should have responsibility for the informed financial consent process for all doctors involved.
"A number of funds are developing a list of practitioners who take part in the fund's no/known gap arrangements for their members to access. The ACCC is aware that Medibank Private maintains lists of providers participating in its no/known gap arrangements. The ACCC also understands that HCF is also developing a data set of doctors and hospitals that its members can access.
"The ACCC supports these initiatives. In the ACCC's view, such lists will provide valuable information for fund members about the practitioners participating in the fund's no/known gap arrangements and the extent of members' exposure to out of pocket expenses".
Professor Fels said the ACCC believed all medical practitioners should also disclose to patients any financial interest they may have in products or services they provide or recommend.
"This will become increasingly important with the amalgamation and vertical integration currently taking place in the medical sector".
*On 25 March 1999 the Australian Senate agreed to the following order during consideration of the Health Legislation Amendment Bill (No 2) 1999:
That there be laid on the table as soon as possible after the end of each period of 6 months, commencing with the 6 months ending on 31 December 1999, a report by the Australian Competition and Consumer Commission containing an assessment of any anti-competitive or other practices by health funds or providers which reduce the extent of health cover for consumers and increase their risk of out-of-pocket and other medical expenses.
This report is the second prepared by the ACCC in compliance with the Senate order, covering the period 1 January to 30 June 2000. The report was tabled in the Senate yesterday.