Putting members’ health before profit

Managed Care risk to Australia’s healthcare system

Australia’s peak not for profit health fund group has accused major for-profit insurers of risking the “Americanisation” of the nation’s medical system.

The CEO of Members Health Fund Alliance*, Matthew Koce, said recent actions and plans by Medibank and nib have the potential to create a ‘managed care’ model in Australia.

“There is a real and present threat to the ability of patients to choose their hospital, their doctor and for interference in clinical care,” he said.

“What we’re seeing is healthcare being driven by organisations operating in the interests of shareholders and investors, rather than members and patient outcomes.

“For-profit health insurance companies buying up GP clinics and partnering with

controversial US managed care experts like Cigna Corporation to set up ‘healthcare data and services’ entities in Australia, should be ringing alarm bells with politicians, regulators,

medical associations and patients.”

Mr Koce said he was in discussions with a range of organisations, including the ACCC, to express serious concerns with recent developments in the health sector.

“What we’re seeing mirrors the path our banks went down in the 1990s and we know where that ended – with the Hayne Royal Commission, its damning findings of conflicts of interest and consumers being ripped off,” he said.

“It beggars belief that some of our major listed health companies, like Medibank and nib, are now going down this same track with initiatives potentially placing GPs and private hospitals in incredibly compromised positions, with the strong possibility for trade-offs between financial returns and patient wellbeing.

“These decisions are being made by for-profit companies seeking to bolster returns to shareholders, and it’s very hard to see how patients and fund members will benefit in the long term.”

Mr Koce said changes were happening by stealth, and the risks to patient care should not be underestimated.

“We need a transparent debate about what Medibank and nib are doing before it’s too late to stop the slow ‘Americanisation’ of our health system, a slide into managed care, and all the dangers that means for the health and wellbeing of Australian families,” he said.

Mr Koce said the culture of Medibank and nib as reflected in their recent moves was arguably one of the drivers behind the consistent and long term growth in membership experienced by Members Health funds.

“Our philosophy and demonstrable actions of putting people before profits has meant we’ve continued to consistently grow our membership year in year out, including increasing the number of members aged under 40 years,” he said.

Members Health is the peak industry body for an alliance of 26 health funds that are not- for-profit or part of a member-owned group, regional or community based. They all share the common ethic of putting their members’ health before profit. Our funds represent the interests of more than 3.7 million Australians.

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