ADA and AMA take on Medibank

Dr Rick Olive ADA
Dr Rick Olive of the ADA

The Australian Medical Association (AMA) has publicly criticized Medibank Private for dismissing established safety and quality guidelines for their own standards. The criticism comes within the context of the dispute between Medibank and Calvary’s private hospitals. Now the Australian Dental Association (ADA) has come out in support of the AMA, with President Dr Rick Olive applauding colleagues for sounding the alarm “about profit-driven private health insurers’ (PHI) increasing interference in the practice and provision of dental care for patients; warning that such practices will spread into and impact on the hospital sector.”

Back in July, Medibank Private announced it would end its contract with private hospitals operated by Calvary after the two parties were unable to agree on rates and quality of services.

The dispute stems from a request from Calvary to Medibank for an increase in rates for services which the insurer said was unsustainable.

Bite covered the story at the time, and you can read that coverage here. In that story, Medibank spokesman Andrew Wilson explained, “We believe it is essential, as a private health insurer, to encourage hospitals to maintain a focus on quality health outcomes for our members, including reducing re-admissions and avoiding preventable, adverse events.”

Dr Rick Olive said: “We applaud the Australian Medical Association’s (AMA) take up of our warnings about the increasing threat to quality healthcare that for-profit private health insurers pose to the Australian community. The President of the AMA, Professor Brian Owler’s recent protests over Medibank Private’s attempts to impose penalty provisions as part of its contract negotiations with Calvary hospitals reflect that the health professions at large are coming to realise the gravity of the situation.

“Australian Government policy effectively provides a permanent revenue stream and subsidies for Australia’s private health insurance industry to the tune of more than $6 billion through the Private Health Insurance Rebate, the Medicare Levy Surcharge and Lifetime Health Cover loading. However the ADA has consistently called out a private health insurance industry that provides policies that do not deliver value for money for consumers. The private health insurance industry’s policies in the dental sector impose lifetime limits, annual limits and exclusions that have no clinical basis whatsoever. In fact, policy holders each year on average pay higher premium increases yet the rebate for dental care under these policies on average have not been revised to reflect the increased health CPI.

“In other words, PHIs have been gradually skimping on their obligations to assist patients with accessing the care that they clinically need. We can see these practices transfer over to Medibank Private’s recent contract terms they are seeking to impose on Calvary hospitals. Although couched in the language of ‘quality’, these proposals are not based on evidence-based clinical best practice. If Calvary hospitals and medical practitioner groups such as the AMA are saying these provisions are not going to maintain safety and quality of healthcare of patients, one must question why Medibank Private continue to insist that these provisions be included.

“While the private health insurance industry are free to pursue efficiencies, the ADA again calls upon the Australian Government to provide legislative safeguards and reforms to ensure that safety and quality is not compromised and that the health profession’s clinical views are respected.

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