I have been writing a lot about Managed Care lately, reminding Australian obstetricians to be wary of the apparent promises made in relation to No Gap Obstetric Models. I’ve also asked you to support NASOG find alternative ways to maintain an affordable and economically viable private obstetric service to the women of Australia where their choice of service provider is protected and defended.
So too, doctors deserve to have the choice to refer to other specialists they believe to be the best provider for their patients, not be forced to refer based on a low-cost contract held by an insurer or hospital.
In the past 24 hours, emails have been sent from a large national private hospital chain in multiple states, giving recipients a two-day time frame to express interest to participate in an HCF and Hospital No Gap Obstetric Model.
Although correspondence from the corporate entity states that it was not their intention to intimidate or force decision making, this tight time frame feels like it has been set to place pressure on doctors and encourage a fear of missing out on any deal on offer. Considered discussion with advisors and colleagues is effectively stifled, leaving doctors forced to make concessions that may have a long-term impact on their career.
Is it essential to be aware that while doctors will be forced to accept cuts in remuneration under these type of arrangements, health funds will continue to implement waiting periods and charge high premiums to cover obstetrics. We have previously argued that obstetrics should be considered a basic component of all health insurance policies, or enjoy the flexibility of psychiatric services, where a patient can upgrade to a policy to include psychiatric admission without a waiting period, on 1 occasion in their lifetime.
It is not clear yet whether private hospitals are taking a cut in bed or theatre fees for this “no gap” product but they will stand to benefit from increased bed occupancy rates and the goodwill that we know private obstetric treatment engenders in women. These happy mothers are frequently the decision makers in how and where to spend the family’s future health dollars.
Obstetric service rebates are not proposed to be indexed to CPI (or other measure) and nor are any proposed additional obstetrician payments, to encourage taking up of these offers, guaranteed to increase in line with escalating costs.
The doctors are not however the only losers with a No Gap Obstetric model.
PATIENTS LOSE CHOICE – the central tenant of private medicine.
We obstetricians and gynaecologists are not alone, craft groups beyond obstetrics are included in the model. Once signed up, you MUST use the IMAGING, PATHOLOGY, ANAESTHETIC and PAEDIATRIC providers that the fund and hospital have decided on.
This means that, like your patients, you have been DENIED CHOICE in providers.
Meanwhile, the health funds and hospitals will continue to maintain profits and run a “business as usual” model. Any perceived savings for patients come through clinicians receiving decreased remuneration for their services and loss of choice in referrals to other specialists.
If obstetricians sign on to these models, our specialty will effectively be sidelined in the discussions on how to really solve the complex problem of affordable private obstetric care. A problem that has arisen over time through inadequate and non-indexed patient rebates from both government and health funds.
We must stand together with our anaesthetic and paediatric colleagues as well as imaging and pathology providers to fight against this intrusion of managed care into our Australian health care system!!!
MAKE NO MISTAKE – this No Gap Obstetric model represents an existential threat to viability and choice of obstetric care in this country.
If you have received one of these emails from a hospital you work with and are making your decision, I urge you to CAREFULLY CONSIDER, not only the future of your craft group but also the larger implications of a financially driven third party influencing patient choice, clinical autonomy and ultimately the entire therapeutic process.
This threat is no longer an emerging risk. It is real and happening in a hospital near you TODAY.
NASOG asks you to keep us informed of any similar incursions into this space. We are maintaining communication with private hospital groups and working closely with other representative associations to find a mutually satisfactory way forward for the profession.
A/Prof Gino Pecoraro