[extract from Australian Medicine, Volume 18, Number 15, August 21, 2006, page 19-20]
Dr Mukesh Haikerwal, AMA President
Informed financial consent has been a key policy of the AMA for some years now. AMA policy has been to support IFC since 1993, and we have progressively increased our focus on it over the years.
Giving good financial consent is as necessary today as getting good medical consent for procedures.
Our hope is that at the end of this campaign we will have mainstreamed IFC into medical practice. That will mean we avoid any punitive legislation.
In addition to behavioural change by doctors, there is a very real need for both health funds and private hospitals to be upfront with patients about their rebates and fees respectively.
The Hon Tony Abbott, Minister for Health and Ageing
Probably the biggest single problem with our existing health insurance system as far as the patients are concerned is the extent of nasty surprises after their procedures are done.
We have marvellous doctors, we have marvellous hospitals, they do an extremely good job clinically, and patients are invariably happy with the outcomes clinically, but they're often quite dissatisfied with what happens afterwards.
So we've got to try to make sure that as far as is humanly possible there aren't any nasty surprises that patients get after the procedure. That's why informed financial consent is very, very important.
Julia Gillard, Shadow Minister for Health
Labor believes it is time for the Howard Government to stop talking and start delivering to Australian families. The increasing unknown gaps in private health insurance products frustrate and worry patients but it is actually the increasing out of pocket costs that hurt families the most.
Anyone in the street will tell you that they are paying more and getting less from their health cover. With every increase in premiums allowed by Tony Abbott, there seems to be more exclusions, hidden fees, caps and charges for members.
Labor in government will fight for a better deal for the privately insured and stop the blame game on informed financial consent.
Dr Greg Deacon, President, Australian Society of Anaesthetists
IFC is a two way street. Patients need to know the cost of their procedure and also their ‘gap’. Only their private health fund can provide that information.
Consequently, we have continually emphasised to the Federal Government that health funds must provide clear written information to patients about their rebates.
It is also impossible for anaesthetists to obtain IFC if we are not given names and contact details of the patient at least five business days in advance of the procedure. We are encouraging all anaesthetists to write to their surgeons on this issue.
We ask our procedural colleagues to assist us with this information flow, and want GPs to remind their patients to ask about costs when they are referred for a procedure.
John Powlay, Private Health Insurance Ombudsman
Most of the complaints my office deals with arise because advance notice of likely costs has not been given or because advice from doctors has been inadequate or unclear.
There are, of course, many factors outside the doctor’s control that contribute to a particular patient facing a bill for ‘the gap’. These include the level of the MBS fee compared to doctor’s fees, the level of health fund benefits, variability in gap schemes, and the advice health funds give to members.
However, advance notice to patients of likely costs remains the best way of ensuring the financial implications of proposed treatment are known.
Dr John Quinn, Executive Director for Surgical Affairs, Royal Australasian College of Surgeons
The Minister for Health remarked recently that surgeons are ‘leaders of the team’ and are responsible for providing informed financial consent for all those involved in an episode of care.
The RACS does not accept that surgeons are responsible for providing such consent from other professionals.
Such health professionals are responsible for providing IFC for their own activities.
However it is reasonable (and expected) to facilitate provision of this information by providing advice as to which other health professionals will be involved in an individual patient’s care and to then provide contact details to facilitate for IFC where possible.
David Kindon, CEO, Australian Association of Pathology Practices
Whether a specimen is sent to the laboratory for analysis, or if on-site analysis is provided during an operation, the patient has no knowledge of the pathologist’s presence.
Clearly, this makes informed financial consent, in the normally accepted sense of the term, impossible.
Until the test is requested, the pathologist has no knowledge of what services might be required, unlike the surgeon or physician attending. Normal IFC processes cannot work in pathology, however other solutions may be adequate.
A patient could be advised that in the event pathology is needed, the financial outcome would depend upon the patient’s private health cover, and the pathology practice’s billing policies.
Often these billing policies, where the gap is not covered by insurance, provide for a modest maximum gap payment per hospital stay.
The Hon Dr Michael Armitage, CEO, Australian Health Industry Association
In addressing the issue of Informed Financial Consent, it is important to put on the record that the AHIA’s view relates to the importance of patients being told by their doctor what he/she will charge for any service to be provided. The AHIA has NO view on the appropriateness or otherwise of the charge.
We know that the absence of 100 per cent Informed Financial Consent (IFC) in elective procedures in Australia is a significant problem. It is one of the most common reasons for privately insured patients becoming dissatisfied and leaving private health insurance, (with negative consequences for everyone).
Consumers and the AHIA appreciate the actions of the majority of doctors who already make a point of providing information to consumers to enable them to give full IFC, but the consumers who aren’t given this information have a right to feel disgruntled. Such a practice is not tolerated in other commercial situations, (e.g. buying a car or a DVD player, etc.), and the AHIA asks why should it be tolerated in the medical setting?
Of course, the provision of IFC is not always possible in emergency situations, and we are happy to work with the Promoting Private Health Group set up by Minister Abbott to ensure a robust definition is agreed, ensuring this area does not become a problem.
The most recent IPSOS Health Care and Insurance Survey indicates that 40 per cent of those encountering a gap were not informed in advance, and that there had been no improvement in the provision of IFC reported over a two year period. Of those receiving appropriate information, 16 per cent reported that they had to ask for it. However, 18 per cent of the population reported that they do not feel comfortable discussing costs with the surgeon. Significantly, 26 per cent of member attrition from Private Health Insurance is impacted by gaps and resultant perceptions of poor value for money.
The Hon Minister Abbott said at the National Press Club on 2 August 2006:
‘The Government also wants to end the nasty surprises when private patients receive their bill by ensuring that doctors and hospitals tell people, in advance, about out of pocket expenses they are likely to face.
‘The Government is planning to conduct a further survey of private patients by the end of the year with a follow up, if necessary, in April next year. If these surveys do not show that IFC has become the norm in elective procedures then the Government will regulate to make it mandatory.’
The AHIA supports regulation if 100 per cent IFC in elective cases cannot be guaranteed.
Health Funds are happy to provide relevant information to their members, but unless the treating doctor informs the patient of the charge, everything else is irrelevant. The issue of IFC is not about medical gaps. It relates solely to a doctor informing the patient of the cost of the service prior to the procedure.
None of the doctors I know would expect to have their house renovated without obtaining a quote. In exactly the same vein, why should a vulnerable and unwell patient be expected to undergo an elective procedure without being informed of the costs in advance?