It's good form to inform and be informed
For 81% of in-patient hospital episodes, there is either no medical gap or if there are any gaps, the patient has been informed. It is a good base but there is room for improvement. Lack of IFC accompanying a medical gap (charges above MBS and health fund rebates) occurs in 19% of all hospital episodes. Anaesthetists, pathologists radiologists and surgical assistants are recognised to have lower rates of IFC, influenced by lower levels of direct patient contact and a lack of knowledge about the exact services that will be required in hospital. The AMA will work specifically with these four provider groups to improve the provision of information about doctors’ fees to patients.
Informed Financial Consent Form
The AMA Informed Financial Consent form complies with all the provisions of the National Health Act and the Health Insurance Act as they affect Gap Cover Schemes. For this reason we recommend that it should be used to provide information to patients about doctors' fees. However there may be some instances where a simpler version is required or preferred. For this reason, you can download the form and make any changes you think might be necessary to encourage good informed financial consent practice and the provision of information about fees to patients.
Prostheses - Informed Financial Consent Form
Private health insurance funds are no longer required by legislation to provide 100% benefit cover (no gap) for all surgically implanted prostheses (medical devices). The new arrangements, which came into effect from midnight on 30 October 2005, set a minimum requirement for at least one clinically appropriate prosthesis to be available for each MBS procedure at 100% benefit cover (no gap).
In reality, for most MBS items, there is a full range of no gap prostheses. The prostheses have been classified into clinically meaningful groups by clinicians and clinicians are involved in the relevant decision making bodies.
Informed Financial Consent for patients is important in those few cases where the only suitable prosthesis is one that attracts a gap. If a prosthesis that attracts less than 100% benefit gap cover is the only one suitable for the job, then the doctor needs to explain to the patient the reasons for this and, where possible, tell the patient how much the gap will be. This should be part of the broader informed financial consent for your medical services.
The reforms are intended to introduce greater competition into the ways prices and benefits are set for the provision of surgically implanted prostheses. This will enable a greater range of prostheses to make their way onto the Prosthesis List and in the long run, will improve the quality of care provided to patients and keep premiums down.
The Australian Private Hospitals Association and Catholic Health Australia have comprehensive information packages regarding the reforms on their websites.
You can download the AMA Informed Financial Consent Form, which includes the information that needs to be given to patients on prostheses, at the bottom of this page.