Fed: Punitive measures on gap payments unnecessary, say doctors

AAP General News (Australia)
12-31-2005
Fed: Punitive measures on gap payments unnecessary, say doctors

By Robin Pash

CANBERRA, Dec 31 AAP - Plans to force surgeons to reveal the full cost of operations
in advance are unnecessary and an act of bad faith, doctors say.

The federal government is considering a plan in which doctors would have to tell private
health patients how much their operation will cost or risk not being paid.

Under the plan, currently being considered by Health Minister Tony Abbott, the Private
Health Insurance Ombudsman would have the power to investigate complaints relating to
gap costs - the difference between what a doctor charges and what a health fund pays.

If the ombudsman ruled that private hospitals had not sought the consent of their patient
to the cost of their treatment, they could rule that the patient should not have to pay.

The plan was put forward by private health funds who have long sought tougher measures
for financial disclosure with gap payments, but the Australian Medical Association today
rejected the idea.

"The current situation is that 80 per cent of the gap payments are known at the time
of surgery," AMA president Mukesh Haikerwal said.

"We have worked very closely with the private health industry and in the new year we're
going to be launching some more information for patients and doctors so that everybody's
aware of the cost of the procedures."

He also accused health funds of acting in bad faith by pushing the plan.

"I think it's an unnecessary measure and it's a measure which smacks of bad faith because
we're working very closely with the health insurers," Dr Haikerwal said.

We're working on a voluntary code, so I'm very surprised to see that suggestion come
through in this form.

"To break ranks and talk about compulsion really is not something that is helpful."

Private health insurers said they would prefer a voluntary code for revealing gap payments,
but said it was time the situation was addressed.

"Everyone would rather it was a voluntary situation," Australian Health Insurance Association
chief Michael Armitage said.

"But I don't think it's too much to expect that patients are told what their medical
treatment is going to cost.

"That to me seems like a really reasonable expectation."

Dr Armitage said talks with doctors and the government were ongoing.

A spokeswoman for Mr Abbott said the plan was among a range of measures being considered
by the minister.

Mr Abbott raised the issue in a speech in June, saying patients ought to know in advance
what their out of pocket expenses would be for operations.

He said the failure to inform patients about gap payments was the biggest grievance
against private health insurers.

AAP rp/lma/de

KEYWORD: DOCTORS NIGHTLEAD

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