IFC – An AMA Priority Since 1993
Hopefully the work commenced by previous AMA Presidents Dr Brendan Nelson and Dr Keith Woollard on informed financial consent (IFC) will come to fruition under the current President Dr Mukesh Haikerwal.
Both gave the issue a lot of importance under their respective Presidencies and both saw clearly that it was an issue needing to be resolved.
Dr Nelson was responsible for the earliest AMA policy declarations in 1993 in support of IFC. Dr Woollard reinforced this position and ensured the AMA promoted its position on IFC and simplified billing.
Subsequently, AMA President Dr David Brand visited this problem and was successful in having Federal legislation passed to introduce Gap Cover Schemes to replace the dreaded Lawrence legislation provisions, which will hopefully eventually be removed as they are recognised as otiose.
Immediately following this legislation, which was not based on individual contracts between doctors and health funds, participation increased to the current level of 81 per cent participation in no gap schemes and five per cent participation in known gap cover schemes.
Given these numbers, it is hard to see how IFC still assumes the political importance that it does.
In the South Australian market, 90 per cent of private inpatient medical services are provided under no gap schemes and six per cent are provided under known gap schemes for which informed financial consent is already legislated. In Victoria, the equivalent figures are 83 per cent and six per cent - making 89 per cent all up.
Yet it does assume a level of political importance, not least because the Federal Health Minister has had a personal experience of unknown medical gaps.
The Government has agreed to allow the profession to run a voluntary education campaign to increase the level of informed financial consent. They have helped the AMA with the resources needed to run the campaign and we appreciate that. The Government has been prepared to put its money where its mouth is.
So have all the specialist groups.
In particular, the Anaesthetists have stepped up to the plate as have the Surgeons, Assistants, Pathologists and Radiologists.
The Consumers have shown an interest and the Private Health Insurance Ombudsman have all been involved and supportive. So too have individual health funds.
The only group lacking enthusiasm and a commitment to contribute to the solution has been the Australian Health Insurance Association (AHIA).
It has consistently run the line that the only solution is draconian legislative sanctions imposed on the medical profession. It continues to run this line in this edition of Australian Medicine.
Rather than concentrate on the very real improvement needed by health insurers to inform their members, in advance of hospitalisation, of the benefits they may receive, we get a lecture on what the medical profession needs to do to lift its game.
There is barely a mention of the role the AHIA could play in improving the level of health fund benefit information provided to members.
It’s as if the AHIA is not aware of the deficiencies in his own industry. It may be unaware, but the medical profession is not.
There is almost no contact between health funds and their members before a hospital episode. The AHIA wants the medical profession to inform health fund members of these details while it is free to argue for punitive legislation on them.
AHIA needs to get its eye on the ball and start lifting its own game or it may wake up one day to find very draconian legislation imposed on its own member funds.
If patients are to be truly aware of the gaps they face from surgery, they need to know both the fee and the benefit.
We are doing our bit but there is no evidence of leadership by the AHIA on their bit.
John O'Dea is the Director of the Medical Practice Policy Department at the Federal AMA.
[Australian Medicine, Volume 18, Number 15, August 21, 2006, page 6]