A room full of health high-flyers has endorsed a six-plank platform for building up the resilience of the dual healthcare system.
A group of high-powered health sector leaders has come up with six principles for reform of the private health and insurance sectors, designed to be a “starting point” for a badly needed honest conversation.
In a free-wheeling discussion at Parliament House in Canberra yesterday, representatives from specialist colleges, patient advocacy groups, private hospitals, not-for-profit insurers picked over the complex challenges facing the dual structure of the health system.
Professor Steve Robson, chief medical officer for medical indemnifiers Avant Mutual, led the forum.
“When I started in this position early this year, there was a palpable sense of despair from a lot of Avant members – that they wouldn’t have anywhere to work, that it was a huge patient safety issue, because they had patients who needed care,” he said.
“There was enormous concern about the viability of a number of private hospitals, particularly in outer urban and rural and regional areas.”
That concern led to the development of the six reform areas, he said, as a starting point for future discussions with government.
“We already now have economic evidence saying that if the [private health] sector fell over, it’s a massive problem for the entire health system of the country,” said Professor Robson.
“There are some things that we can do quickly, some easy things that we can do to help the sector.”
The six reform areas are:
- Equity and fair access: promote parity in workforce support, service quality, and funding between public and private hospitals to ensure all patients and clinicians have equitable access to care and sustainable working conditions;
- Innovation and flexibility in financing: support the creation of modern, patient-driven funding models to increase participation in private health and improve cost sustainability;
- Strategic investment in critical health infrastructure and access: build capacity through workforce development, IT upgrades, and facility improvements;
- Transparency and accountability in pricing: introduce nationally consistent frameworks and negotiation guidelines for pricing for privately funded hospital services to reduce fragmentation, improve transparency, and prevent negotiation impasses between insurers and providers;
- Regulating vertical integration: establish fair market conditions by placing limits on PHI investment in clinical service delivery;
- Shared responsibility for a sustainable private health system: ensure the long-term sustainability of the private health sector through structured collaboration between governments, insurers and providers, with shared accountability for reform and system efficiency.
“One of the ideas that we wanted to test with the group was around nationally consistent frameworks and negotiation guidelines for pricing these privately funded hospital services, to try to reduce this fragmentation, and aggressive standoffs that play out in the media, and always sandwich patients, patients who need care and just can’t get it,” said Professor Robson.
Of particular concern to Professor Robson, a practicing obstetrician and gynaecologist working in both the public and private sectors, was the regulation of vertical integration, with the increasing involvement of private health funds in hospital ownership and management.
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“One of the things that doctors treasure and patients should treasure is the doctor-patient relationship,” he said.
“It is time honoured, and there is strong evidence to tell us that when a doctor and a patient work together, they’re much more likely to come up with the right solution for the patient, rather than having some other entity intrude themselves.
“Vertical integration is about payers who say ‘we will control the general practitioners, who will only refer if certain conditions are met, to specialists that we approve of, who will only operate if certain conditions are met in our facilities, and will only do the operations we let them do’.
“This is a model directly taken from the United States that has delivered catastrophic results for American patients and for the health system.
“I know that lots of people are saying, ‘oh, that could never happen here’, but we are seeing it happen, let’s be honest.”