The community seeks better information from hospitals, medical and other health practitioners and health funds about the products or services they provide, the Australian Competition and Consumer Commission has found.
"This is a recurrent theme in the ACCC report on private health insurance tabled in the Senate today," ACCC Chairman, Professor Allan Fels, said today. "The report follows an order from the Senate that the ACCC assess any anti-competitive and other practices by health funds or providers that reduced the extent of health cover for consumers and increased their out-of-pocket and other expenses.
"The report examines the dealings between health funds, hospitals, medical and allied health practitioners, as well as consumers' concerns in the private health care sector.
"Health fund members are benefiting from a regime of no or known gap for hospital accommodation services, provided they utilise a hospital that has a contract with their health fund. This flows from the contracts funds have negotiated with private hospitals.
"Submissions from the hospital sector levelled criticisms at the conduct of health funds in relation to contracting for hospital services. The ACCC is monitoring the health fund-hospital contracting environment and is committed to pursue any matter raising trade practices issues.
"The medical gap is a major consumer concern and a key reason for public dissatisfaction with private health insurance.
"Some doctors and their professional associations have expressed firm philosophical opposition to contracting with health funds, arguing such contracts would lead funds interfering with doctors' clinical independence. The ACCC notes that AXA Australia Health Insurance's Ezyclaim, a transaction-by-transaction arrangement, is used by more than 1,600 doctors in Victoria and South Australia, and is successfully delivering no-gap cover to over 9,000 patients a month.
"The ACCC is not aware of any concerns by doctors participating in this arrangement about actual or potential interference with their clinical independence.
"The report also highlights problems consumers may have in making informed decisions about their health choices.
"For consumers to make an informed choice about their medical or allied health practitioners, they must have information on quality and price of a range of practitioners. The community debates about no gap or known gap health insurance products highlights the importance for consumers of price and price information in this sector. Practitioners, their professional associations and health funds have a role to play to better inform the community about medical and health services."
"Complaints from consumers to the Private Health Insurance Ombudsman and the ACCC have raised issues of concern with private health insurance, including confusion about entitlements, pre-existing ailments, transferability of cover and changes to benefit entitlements.
"A clear message is that health funds need to provide adequate information to their members about their product, at the time of purchase and when introducing changes
"Failure to do so may, in some circumstances, constitute a breach of the Trade Practices Act 1974. The ACCC will continue to investigate allegations in this area.
"The ACCC received 33 submissions from the health fund, hospital, medical and allied health sectors, as well as consumer organisations, State and Territory health complaints bodies, the Private Health Insurance Ombudsman and the Department of Health and Aged Care".
Copies of the Report can be obtained from Ms Isabelle Arnaud on 02 6243 1049.