ASO warns against US-style managed care as ACCC considers authorising buying group

MedTech News: The private health insurers lobby regularly with the Federal Government claiming a crisis of affordability in private health insurance and request for increased funding and regulatory changes designed to control the private healthcare sector.

In an interview with Health Industry Hub, Dr Peter Sumich, Vice President, Australian Society of Ophthalmologists (ASO), provided his views on health insurers seeking to enter the ownership of private medical and surgical facilities in Australia. He detailed the adverse impact of US-style managed care on clinicians, clinical practice and patient care, if this was to be adopted locally.

In light of the recent ACCC issued draft determination to authorise Honeysuckle Health (Cigna/nib health funds) to form a health services buying group, the ASO has launched an awareness campaign to alert Australians to the dangers of US-style managed healthcare and the potential adverse consequences for insured patients.

“This is another paradigm shifting moment where we have to see that this partnership between Cigna and nib is an inch too far,” stated Dr Sumich.

The 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.

Managed care is very profitable for health insurers but can be disastrous for patients as experience in the US shows.

The ASO and other medical bodies including the AMA will attempt to persuade the Federal Government to protect privately insured patients by strengthening the Health Act and introducing anti-managed care legislation.

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