Private Health Insurance Updates

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Earlier this year, the recently privatised Medibank Private Ltd (MPL) announced its contract with Calvary Private Healthcare would end on 31 August.

As negotiations commenced, AMA and AMA Queensland, as well as other key stakeholders, expressed serious concern at the proposed contract, particularly its inclusion of a quality clause that noted 165 so-called highly-preventable events and a refusal to pay for hospital readmissions within 28 days.

Since the original contract was proposed, MPL and Calvary have reached an agreement, the terms of which are private.

The decision to keep the details of the quality and safety clause private is one that creates uncertainty for patients, lacks transparency and sets a dangerous precedent for other negotiation between hospitals and private health insurers. AMA and AMA Queensland are calling for these details to be made public to ensure any quality measures protect the best interests of patients and are quality driven rather than financially motivated.

Safety and quality measures should be clinically driven, robust and assessed and validated by an independent body.  This work is currently being done by the Australian Commission on Safety and Quality in Health Care, which the Minister for Health has asked be fast-tracked.  When finalised, these measures should apply to public and private hospitals to identify prevalent hospital complications so that hospitals can take action to remedy them.

The AMA is of the view that no insurer should seek to impose their own safety and quality measures onto hospitals via their commercial contracts.

Though these negotiations have now reached an agreement, the AMA remains concerned that Medibank and other insurers will continue trying to insert themselves in the patient-doctor relationship.

AMA has called on the Commission to work with insurers, alongside clinicians and private hospitals, to work on ways we can improve quality in our private hospital system and make sure we continue to have the proper balance between public and private hospitals.

We will continue to keep you updated on any developments via your regular AMA Queensland communication.

More information

AMA Transcript - Medibank Private and Calvary Hospital