ADA backs Calvary against PI

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Dr Rick Olive
Dr Rick Olive from the ADA

The ADA has weighed into a fight between health insurer Medibank Private and Calvary Health Care, accusing the insurer of aggressive interference. But others are saying Medibank’s hardline approach is a victory for containing health costs for consumers.

Earlier this month, Medibank Private announced it would end its contract with private hospitals operated by Calgary after the two parties were unable to agree on rates and quality of services.

Calvary had asked for an increase in rates for services which the insurer said was unsustainable.

Last month, Medibank spokesman Andrew Wilson explained that the insurer was committed to providing its members with access to “quality private hospital services at reasonable prices”.

“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,” he said.

“We also feel we have a responsibility to work with hospitals to help reduce unwarranted upward pressure on member premiums. We think it’s the right thing to do to ensure our members get the best quality care at an affordable and sustainable cost.”

However, President of the ADA, Dr Rick Olive AM RFD, came out in support of Calvary, saying: “What we are seeing in these negotiations is the beginning of more aggressive moves by certain private health insurers to interfere in the clinical practices and frameworks used by established health services. Financial considerations of the insurer rather than what is clinically appropriate in the delivery of health to its members is becoming the main driver of how it wants to provide healthcare.

“For years, the ADA has routinely alerted the public, its members and regulators about aggressive approaches of private health insurers in dentistry. Private health insurers’ placement of annual and lifetime limits on benefits paid, exclusion of cover for some treatments and their failure to review their rebates in line with the ever increasing premium increases or CPI or at all in some cases have been the issues the ADA has raised. The ADA maintains that PHIs are obliged to meet their obligations to insure services for patients who undertake treatment outlined on the advice of their dentist. There is no public policy reason to justify restricting or limiting the care that policyholders clinically are required to receive.”

The ADA alerts the public that these aggressive moves by Medibank to Calvary are an indication of private health insurers appointing themselves as the gatekeepers to appropriate healthcare. When private health insurers demand that policyholders change their health providers, those policyholders should consider changing their private health insurer instead.

Dr Olive concluded: “The crucial missing pieces to comprehensive private health insurance reform are changes to the regulations underpinning this industry to always ensure that efficiencies or cost cutting are never done at the expense of evidence-based safety and quality health considerations for policy holders. These current moves by the one of the biggest private health insurers in the country are an indication of what is to come in the private health sector if there is no action taken by the Australian Government.”

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