PHA CEO Dr Rachel David speaks with ABC Radio Darwin on preventative health programs

Station: ABC Radio Darwin
Program: Late Breakfast
Date: 24/1/2023
Time: 8:37 AM
Compere: Adam Steer
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


ADAM STEER: Are you someone who’s always used a bulk-billing doctor? If you have, then at some time over the last 12 months, you may have got a shock when you were attending your regular GP. Medical centres with multiple clinics in Darwin, including Arafura Medical and Top End Medical, moved to a mixed billing model, citing an increase in overheads. So with more and more people paying a gap on Medicare than ever before, should private health cover be able to pay it? That’s what the health funds are calling for this morning. Dr Rachel David is the CEO of Private Healthcare Australia. Dr David, welcome to the top end of the Northern Territory. Why do health funds want to intervene here?
RACHEL DAVID: Well, look, traditionally, health funds have been very good at doing what they’re regulated to do, which is to fund care in a hospital. Now, the system which bolts private health insurance into Medicare was put together about 40 years ago in an era where we didn’t even have the same diseases that we have now. Nowadays, we- people suffer much more from chronic diseases which can be prevented, and the trouble is that private health funds are prevented by regulation for actually funding anything in primary care that would really help prevent disease. And that’s really what we’re shooting for here. So what we can do is we can fund programs in the community or in primary care which substitute for hospital treatment. But what we can’t do is get in and help GPs do some of the preventive programs that can stop people going into hospital in the first place.
ADAM STEER: Is this about increasing premiums, though? Sounds like it.
RACHEL DAVID: Well, look, we do everything we can to keep a lid on premiums in spite of the fact that health costs actually rise like any other form of inflation, and at the moment, that’s a particular challenge given the inflationary environment. But as people live longer and are experiencing more chronic diseases, we need to work harder to make sure that they’re not admitted to hospital for reasons that are preventable. Now, GPs are a really critical part of that, GPs and the people who work for them, whether it’s mental health checks, heart health checks, and some of the other tests that people need and some of the other investigations that they might need in the community and primary care. We can’t contribute to that even though our members want us to. And that’s one of the things that, you know, if we are looking at a bit of an overhaul of a system which has served us well for 40 years, that I think that this is a source of funding that should be included.
ADAM STEER: But premiums would be increased, though, wouldn’t they, if you then say: look, we’re offering a new service, it’s your GP?
RACHEL DAVID: Well, look, not necessarily, and I think this is where some further work does need to be done. If the program that we were talking- the programs we were talking about funding were appropriately targeted, that is to preventive health- the preventive health activities that GPs are undertaking and they were designed to preventing people going into hospital, then there’s no- then the impact on premiums could be quite neutral. And the reason for that is the most expensive place to get health care is in a hospital, particularly if you’ve been admitted unexpectedly.
ADAM STEER: What percentage of people in Australia have private health cover? Do you know that, Dr David?
RACHEL DAVID: It’s just over 50 per cent or just over 14 million people.
ADAM STEER: Okay. And so has that increased or decreased during and since the pandemic?
RACHEL DAVID: Look, since the pandemic, it’s increased quite markedly. For a while there it looked as if membership was falling off, particularly in younger people who were struggling with cost of living. But since the pandemic, we’ve seen about a million people joined and it’s all around Australia, but particularly in areas where public hospitals have been struggling and waiting lists have been high.
ADAM STEER: You’re on ABC Radio Darwin. Adam Steer and Jo Laverty with you. Dr Rachel David is the CEO of Private Healthcare Australia. What sort of legislation would be needed to allow private health to pay that Medicare gap?
RACHEL DAVID: Well, look, I think in the first place there’s some legislation that is out of date that’s in place at the moment, and that actually has a list in there of people- the sorts of people that private health funds can actually fund in the community sector, and that list excludes nurses and GP’s. I think the first thing is that list of people needs to go. It is about- that legislations about 15 years old and it’s really not relevant for the current way in which preventive care takes place in the community. Once that happens, I think we can look at what models of funding might be suitable to help people with their health if they have a chronic illness and help them to stay out of hospital.
ADAM STEER: Well, I’m confused about that. I pay for my GP and they have details of my private health care.
RACHEL DAVID: Well look, that may be so, but that doesn’t mean that the health fund can pay that GP or support that GP practice. What that’s usually therefore is so that if the GP needs to refer you to a private specialist, they know that you’re covered for any hospital care that you might need.
ADAM STEER: Wouldn’t this issue be somewhat fixed by a substantial increase to the Medicare rebate?
RACHEL DAVID: Well look, that is something that the GP’s have put forward. I do agree that general practice, given the critical role that they have in our community, has been underfunded for some years, and that’s been a problem that’s built up under multiple Health Ministers and Federal Governments, so it’s not down to the fault of one person. But the problem is that because of the number of GP services even a small increase in the MBS rebate is a huge hit to the budget. That’s something that, you know- that is- we’re talking about billions and billions of dollars.

Some people are out there talking for the MBS rebate to be tripled, for example. So to do that when Australia already is trying to service a $1 trillion debt, you have to be really sure that it will fix the bulk billing problem and it will be bring more GP’s into the workforce. So it’s a very complex issue.

ADAM STEER: The gap for most of the bulk billing practices that I mentioned at the beginning of the interview, I think that gaps around $20 to $25 per patient. Is the economy of scale okay? If you say: right, I’m going to take out private health insurance for the first time so I don’t have to pay that $25 every time I go and see the doc?
RACHEL DAVID: Well, look, I think what we’re talking about is not necessarily something that would cover the gap under all circumstances for all doctors. I think really this is something that needs to be targeted to preventive health and to some of the more complex work that GPS do to assess people for risk factors, for particular things like heart disease and mental illness, and put in place a plan for them so that they don’t go on to get sick and get admitted to hospital.
ADAM STEER: Okay. So if you’re just turning up to the doctor because you’ve got a sore throat, then you’d still have to pay the gap under this proposal?
RACHEL DAVID: Yes. Look, I think that in all circumstances, for all cases. I mean, if we were to- if health funds were to go ahead and just propose a kind of gap insurance for every type of patient that turned up, that would not be sustainable. But I think a model where a co-contribution for preventive care and certain types of work by general practitioners that might substitute for a hospital admission. And there I think there are some GP’s around who do some phenomenal work in the management of things like drug and alcohol, substance use disorder in the community, like, they help people beat alcohol and detox from alcohol in the community. And I think that’s something that we can and should be able to fund.
ADAM STEER: Dr Rachel David, it is a pleasure to talk to you this morning. Thank you so much for your time.
RACHEL DAVID: Thanks, Adam.
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