Private health insurers own around 15% of Australia’s general practice chains, and counting, if Bupa’s move to acquire the Partnered Health group is approved by the ACCC and Foreign Investment Review Board this year — but new data shows many GPs are worried about the implications of insurers’ expanding role.
A national Healthed poll of almost 1500 GPs found that 64% are uncomfortable with health insurers owning GP clinics in Australia. Just 5% said they feel comfortable with it, and 29% are undecided.
Less than one in five GPs (16%) feel existing regulations are adequate to manage the risks.
Reduced autonomy over how GPs practise was the biggest concern, reported by 37% of GPs. Erosion of GP-owned independent practices was the next most common concern, cited by 20% of respondents.
The survey highlighted deep scepticism from GPs.
For example, 36% said they thought influencing referrals, imaging and admissions to reduce claims costs was a “major factor” in health insurance company decisions to buy GP clinics. A further 31% of GPs thought it was a “moderate factor,” while 10% felt it was a “minor factor.” Only 2% thought it was not a factor – though 21% said they were unsure.
Like GPs in Healthed’s survey, the AMA is wary that doctors in clinics owned by insurers could be pressured to refer to certain hospitals or preferred specialists.
AMA vice president Julian Rait told the ABC that “Over a period of time, various perverse incentives can creep into such arrangements, and that’s why we’re very concerned.”
Six out of 10 GPs think that an agenda of influencing GPs behaviour is either a major or moderate factor in insurers purchasing general practice clinics.
While insurers ostensibly say they are motivated to invest in prevention and chronic disease management to keep people well, just 14% of GPs believed this was a major factor and 24% thought it was a moderate factor, while 27% felt it was a minor factor in their decision to buy GP clinics.
Sixty percent of GPs in the survey felt patients should be explicitly told when their clinic is owned by an insurer – and probably not coincidently a similar proportion felt that the dynamic threatens the clinical independence of GPs, and that doctors would face pressure to refer within an insurer-preferred network.
Insurer ownership is accelerating
However, overall the number of GPs working in insurance run clinics is still small. Only 2% of GPs in the Healthed survey said they worked at a practice owned (or partially owned) by a private health insurer.
Insurers argue they are responding to consumer demand for convenience, prevention and coordinated care.
Medibank and Bupa both offer free telehealth consults for members via insurer‑owned GP networks.
They are able to do this due to a loophole that allows health insurers to subsidise services if there is no Medicare rebate – which there isn’t for telehealth services in cases where the doctor hasn’t had a face-to-face consultation with the patient in the past 12 months,
Medibank says demand for its virtual GP service rose 34% between July and August, citing access challenges in rural areas and workforce shortages.
Meanwhile Bupa is pushing for legislative changes that would allow PHI to fund prevention, early intervention and chronic disease management outside of a hospital setting.
However, Associate Professor Rashmi Sharma, the Chair of the RACGP Funding and Health System Reform expert committee, told newsGP that without proper safeguards that could create access issues, fragmented care and contribute to a two-tiered system.
The latter is also a criticism of insurer owned GP clinics more broadly. Many, including the AMA and Catholic Health Australia, said it was step toward a two-tiered system – and 58% of GPs in the survey agreed.
What your colleagues are saying
“The Australian public need to be made aware this is a clear step towards the US style healthcare, and should be avoided at all costs.”
“He who pays the piper dictates the tune.”
“Another way to control GPs.”
“Because of conflict of interest, patients will be referred to certain specialist and hospitals to reduce cost for the insurance company.”
“I have spoken to some dentists who have worked in private health insurance owned dental practices. They described significant deviation in care provided in these centres to maximise financial income at the detriment to patient outcomes. I fear a similar occurrance would occur in general practice. It has the potential to add a significant conflict of interest that may overpower providing evidence patient centred care.”
“GPs in insured owned practices will progressively lose their independence in all aspects of their practice. Insurer owned practices will inevitably split the entire Australian society into new 2 un-reconcilable classes.”
“There may be benefits from improved resources and coordination, but potential conflicts of interest and pressure on clinical decision-making could affect patient care.”
“Practice owners who are not supported to develop genuine management skills are more likely to sell to corporate groups.”
“We already have a two-tiered healthcare system in Australia, and it is getting worse and less equitable all the time.”
“Private health insurer involvement in primary care is the beginning of the end of good quality equitable, accessible, patient care.”
“There is already a two-tiered health system in Australia as very limited access to specialists via public clinics!”
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