Support for medical tourism


nibwebLast year, Australian health fund, NIB, dropped a couple of bombshells that sent healthcare providers reeling. The first was the launch of its online directory, Whitecoat, which is now up and running. The second was its plan to establish a service through which members of the public could book medical and dental travel.

Both proposals were controversial. The health fund was accused of undermining Australian practitioners. The schemes attracted a barrage of claim and counter-claim from NIB, the Australian Dentists Association (ADA) and the Australian Medical Association (AMA). Then, last month, the Australian Health Practitioner Regulation Agency (AHPRA) weighed in with a new set of guidelines on advertising and social media.

So just what is all this fuss about? How do these new NIB offerings, and AHPRA’s guidelines, affect the average dentist? And is NIB on a mission to alienate Australian healthcare providers? We’ve asked the main players to lay their cards on the table.

Whitecoat ( is an online directory of healthcare providers. Members of the public can search for practitioners by suburb or postcode and compare them on the basis of cost and a “likelihood to recommend” score.

The information is gathered by NIB from its members when they make a claim. Providers listed are those who have treated NIB members and are registered for HICAPS.

The ADA has been critical of Whitecoat on a number of grounds but the most serious issue concerns the member reviews that appear on practitioners’ profiles.

Section 133 of the Health Practitioner Regulation National Law prohibits the use of testimonials by healthcare providers in advertising or social media. NIB maintains that its member reviews are not testimonials. The ADA is not so sure.

“We have legal advice to the effect that NIB may be guilty of an offence if it publishes testimonials,” says chair of the ADA Schedule Committee, Dr Terry Pitsikas. “If dentists are aware of testimonials relating to them on the Whitecoat website and they do not have them removed, then they may also be in breach of the law. So we advise dentists not to become involved.”

NIB’s Justin Vaughan is equally determined that Whitecoat’s reviews do not contravene the National Law. “We have consulted extensively with AHPRA and they appear comfortable with the way we moderate customer comments,” he insists. “In our view, we are confident that the Whitecoat site sits within their guidelines.”

So who is right? AHPRA’s revised guidelines indicate that the type of reviews published on the Whitecoat website would be in breach of the
National Law if they included information of a clinical nature. According to the guidelines:

“… A review on a social media site that states, ‘Appointment ran very late and magazines were old,’ is not considered a testimonial as it makes no reference to the clinical care provided… However, a review… that states ‘Practitioner was quick to diagnose my illness and gave excellent treatment,’ is a testimonial which references clinical care and is considered in breach of the National Law.’

AHPRA CEO Martin Fletcher has confirmed that AHPRA liaised closely with NIB in preparation for the launch of Whitecoat and made its expectations “abundantly clear” but he has not yet given a public assurance that those expectations have been met.

The Whitecoat website states: “Comments of a clinical nature will not be published.” It is not, however, always easy to draw that line. Here are some excerpts from reviews that we found on the site in February this year.

“A very pleasant person with an approachable manner.” We can safely assume that is not a clinical comment, but what about: “Did a thorough check-up including checking for lumps/abnormalities.” Or even: “Service was excellent. Didn’t hurt a bit!” It is no surprise that the ADA is advising caution.

The ADA has also queried the quality and reliability of the information on the site but NIB maintains that it avoids the faux postings and other pitfalls of well-known travel and restaurant review sites by only surveying members about practitioners who they have recently and evidently visited.

Justin Vaughan defends the site’s “likelihood to recommend” rating on the basis that “there is evidence internationally that patient satisfaction is closely associated with overall quality.” And he considers the site’s price scale to be fair. “We make price quite transparent and we don’t apologise for that,” he says. “We use a robust mechanism to assess pricing, and this has been reviewed by a leading actuarial firm.”

Nor does Vaughan apologise for NIB’s soon-to-launch service, Options, which has been criticised roundly for encouraging medical tourism at the expense of Australian providers.

Vaughan sees NIB Options as “offering a safe, reliable and affordable service to the tens of thousands of Australians who are considering medical and dental procedures in Australia and overseas.” Dr Terry Pitsikas, however, sees it as a bid to turn a greater profit for NIB shareholders with little or no regard for its impact on local doctors and dentists.

The one-stop booking service is not an insurance product and will be separate from NIB’s business as a health fund. It will create packages that include airfares, accommodation, concierge services, overseas medical and dental treatments and before-and-after care by Australian practitioners. It will also provide clients with treatment options in Australia.

“Our aim,” says Vaughan, “is to provide choice, and to provide peace of mind for those who travel overseas for medical and dental procedures. They can feel confident that, when they book their procedure and travel through NIB Options, the procedure will be performed by reputable, independently accredited clinical specialists and facilities.”

Dr Pitsikas is, however, sceptical. “There are some excellent healthcare providers working internationally,” he explains, “but there are not always the same quality assurances that we have in Australia. Australia sets high requirements of registration and standards that need to be met by facilities and healthcare providers. Many overseas jurisdictions don’t have such stringent regulations.”

Dr Pitsikas suggests a number of possible risks for the medical tourist, from sub-standard clinical work to infection with multidrug-resistant organisms. Nor is he convinced that the Options plan will be able to successfully factor in the variability of overseas dentistry.

“As dentists, we see some cases where the overseas work has been quite good, but we also see a lot of cases where complex and often expensive remedial work is required because the overseas procedure wasn’t good at all. I don’t understand how Options will be able to factor that sort of extended care and remedial work into one initial quote and make it viable for everyone— dentists, clients and NIB shareholders.”

Both the ADA and the AMA are also justifiably concerned that, by enabling increased medical tourism, NIB’s Options service will drive clients away from Australian doctors and dentists.

Vaughan denies those charges, insisting that Options will provide clients with quotes for local, as well overseas, treatment packages. “In some instances,” he suggests, “the price differential might not be as great as people think,” and they might choose the local alternative.

So, is NIB on a mission to undermine Aussie practitioners? Vaughan says no.

“We appreciate people’s initial anxiety and caution around travelling overseas for treatment, and we’re conscious that we have to do a really good job,” Vaughan says. “That’s why we are placing a strong emphasis on clinical governance, safety, quality and customer service. We need to ensure that this enhances the NIB brand, rather than risking its reputation.”

It is impossible to gauge how those local and international quotes will stack up, and whether the ADA’s worst fears will be realised, until the service is up and running. Options is due to launch in the coming months.

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