ASO slams health insurance deal

The Australian Society of Ophthalmologists (ASO) has launched a campaign to alert Australians to the dangers of US-style managed healthcare and the potential consequences for insured patients.

ASO’s ‘Send the eagle home’ campaign, urging the public to lobby their local federal member to reject US-managed healthcare in Australia, was launched in response to Australian NIB health insurance’s decision to pursue a joint venture with US managed-care giant Cigna Healthcorp, which has revenues of more than US$160 billion.

According to the ASO, the Australian Competition & Consumer Commission (ACCC) draft recommendation allows for 40% of the Australian marketplace to be consumed by this joint venture, which will force other insurers to respond. Insurers can minimise payouts by organising discount health packages through bundling the doctor, hospital and treatment plan which they contract together based on minimal costs, the ASO said in a statement.

Leading the charge, ASO vice president Dr Peter Sumich said, “Cigna didn’t come to Australia just to see the Harbour Bridge.

“Health insurers want the doctor controlled by a contract so cost savings can be made on hospital admissions, cheaper treatments and cheaper prosthetic implants. Under US managed care, the patient must accept whatever treatment the insurer contracts for them. The insurer calls the shots. Critics might suggest protesting doctors are just protecting their incomes, but ironically doctors can be paid more to take these contracts as long as they adhere to the insurer’s contract requirements.”

The ASO and other medical bodies will try to persuade the federal government to “protect” privately insured patients by strengthening the Health Act and introducing anti-managed care legislation, said Dr Sumich. “Other countries have already successfully introduced such legislation as a deterrent to managed care.”

Australia’s Council of Procedural Specialists (COPS) has also weighed in, stating that its members are concerned that, “‘health fund determined concepts of value’ are imposed by confidential contractual arrangements between third party payers and those who deliver healthcare… Australians should not be used as an experiment to road-test unseen and unapproved value-based contracts.”

Seeming to back the opposition to the joint venture, Australia’s health minister Greg Hunt told health funds that the government does not support the local industry creeping into US-style managed care. However, in September 2020, Hunt's plan to let private patients access hospital treatments at home under their health insurance sparked debate over how much control funds should have over care. Catholic Health Australia, however, welcomed the announcement, pointing out in a report that treatment at home could free-up 200,000 hospital beds a year, while Private Healthcare Australia chief executive Rachel David said health funds supported the hospital-in-the-home project in principle and that during the pandemic "a whole lot of people with medical conditions no longer think going to hospital is safe."

Announcing the Cigna venture in December 2019, NIB managing director Mark Fitzgibbon said, “As a business we’re determined to help our members, in collaboration with their doctors, keep healthy rather than simply be there for them when they’re already sick or injured. And with over 740,000 avoidable hospital admissions in Australia every year, representing approximately 7% of all hospitalisations, we think there’s an enormous role for the joint venture to play.”

For more, see, www.sendtheeaglehome.com.au