The Australian Competition and Consumer Commission continues to be concerned about consumers access to information about the cost of, and financial interests in, those providing medical services, ACCC Chairman, Professor Allan Fels, said today.
After tabling its third Report to the Senate* on anti-competitive and other practices by health funds or providers which reduce the extent of health cover for consumers, the ACCC expressed concerns that:
- some in the medical profession do not seem to be able to appreciate the significance of cost as one important consideration in the provision of specialist care
- in particular cases, patients may not be adequately informed about the commercial or financial interests of medical practitioners when they refer patients to other practitioners, for example interests in radiology or pathology services
- health funds advertising may have misled consumers
The ACCC noted positive developments:
- in the provision by health funds of information on their no-gap/known gap arrangements to their members
- the increased number of funds offering no-gap/known-gap arrangements
- the level of usage of no-gap/known-gap arrangements by health fund members has continued to increase significantly - highlighting the importance consumers place on costs for medical services
No gap information
The ACCC supports those health funds which have provided information to their members to give them a better understanding of services with no out-of-pocket expense or 'gap'.
A number of health funds have given their members a list of practitioners who take part in their no-gap/known-gap arrangements. The ACCC welcomes these initiatives. They provide valuable information to members about the specialists taking part in the funds' no-gap/known-gap arrangements, the extent of the members' exposure to out-of-pocket expenses, in addition to the other relevant factors that members take into account when being referred to a specialist.
The ACCC is concerned that the Australian Medical Association has not acknowledged the significance of cost as one important consideration in the provision of specialist medical health care. In fact, public comments by the AMA and some in the medical profession reflect a lack of understanding of cost as an important factor in selecting specialist medical services. The AMA seems more concerned with the interests of the medical profession, than the interests of consumers.
Informed financial consent
Legislative changes in other sectors, including the financial services industry, reflect an increased community demand that consumers should be informed of the financial interests of those who provide advice. This aims to remove the information imbalance between the adviser and the advised and to safeguard against abuse. The ACCC believes the health sector should be no different.
The ACCC believes patients should be informed of any likely costs involved in medical procedures. Informed consent does not only involve practitioners telling patients about the likely costs of medical treatment, but also requires doctors to tell patients of any financial interest that doctors have in recommending particular treatments or services.
The ACCC has also called for, and will carefully consider the prospects of, pursuing matters where consumers are not informed of the extent of the costs involved in medical treatment.
Recent Action taken by ACCC
The unprecedented increase in new members taking up private health insurance following the introduction of Lifetime Health Cover resulted in the ACCC receiving many complaints from consumers. These complaints related to allegations of misleading or deceptive conduct in relation to funds' advertising and other promotional material and misrepresentations by funds' staff about parts of the funds' products. Members misunderstood certain aspects of their health insurance policies, especially waiting periods and pre-existing ailments.
As a result, the ACCC instituted proceedings against Medibank Private and MBF, alleging misleading and deceptive advertising in the promotion of their products.
The ACCC also obtained court-enforceable undertakings from Medibank Private over unconscionable conduct concerns following the attempted imposition of a unilateral variation clause contained within the proposed contract with a small, independent specialist hospital. Unconscionable conduct remains a priority for the ACCC, who will continue to monitor the health funds/hospitals negotiating process.
Within the health sector, the ACCC recognises the public interest of allowing smaller regional hospitals to negotiate collectively with large health funds and recently authorised a group of small regional hospitals to jointly negotiate with health funds.
The ACCC notes the deregulation of the market for surgically implanted prostheses. It will aim to ensure private health insurance costs and general costs in respect of health are reined in and greater competition evolves. The ACCC will be vigilant in ensuring these objectives are not frustrated by anti-competitive practices.