BUPA and NIB call for review of legislation to extend private cover to GPs

Doctors and Australia’s largest health insurers BUPA and NIB have united in a call for a review of legislation to extend private cover to GPs so patients can claim out of pocket costs for primary care services.

Doctors and private health insurers are calling on the federal government to allow the extension of private health insurance to cover GPs in a bid to reverse climbing premiums and shrinking Medicare cover.

Australia’s largest health insurers BUPA and NIB are clamouring for a review of legislation to extend private cover to GPs so the patient can claim out of pocket costs for primary care services through health funds.

In a move supported by the Australian Medical Association, the call for change would mean reviewing government legislation to encourage preventive care options and allow more out-of-hospital care.

“The health and well being of Australians can be enhanced with reforms that put consumers first and improve the relevance and affordability of private health care — this includes removing restrictions so insurers have more flexibility to contribute to some primary and secondary prevention in general practice or other out-of-hospital settings,” a BUPA spokesman said.

NIB echoed calls for reform with CEO Mark Fitzgibbon saying, “We should be able to cover our members wherever they meet the healthcare system.

RACGP President, Professor Karen Price, said Medicare rebates have not kept pace with the cost of high-quality general practice care

“The logic for limiting private health insurance cover to only Medicare co-pays within a hospital is lost in time. It leads to confusion, high out-of-pocket expenses and a bias towards unwarranted hospitalisation.”

GP Jason Cooke of Newington Medical said general practices are struggling due to chronic underfunding by Medicare with the axing of Medicare payments.

GP Jason Cooke of Newington Medical.

“Next year’s medico legal insurance premiums are set to rise substantially, which means more costs to GPs will be passed on to patients — general practice more than ever needs to access more funding, due to no increases of government investment in primary care for more than 10 years,” he said.

“General practices have been specifically targeted by the Government to be excluded from this funding option.

“Private health insurers have expressed significant interest in funding primary care services to the public. It would lead to significant cost savings to the health funds and therefore to the public.

“Primary care is cheaper than costly secondary and tertiary care in hospitals. An ounce of prevention is worth a pound of cure. GPs may also be more inclined to bulk bill services to those in need if they were afforded more funding from the private sector,” he said.

Sydney GP Doctor Meena Qidwai. Picture: David Swift.

Sydney GP Meena Qidwai said the $39.10 Medicare rebate for a standard 20-minute consultation was still poor and if the out of pocket costs were assisted by private insurers it would help fund practices.

“If the government reviewed legislation to enable general practice to access private funding, even for GP consultations, it would be hugely beneficial if we could co-claim with Medicare,” she said.

Since the 1976 introduction of Medicare as the universal health care insurer, general practice has been banned from accessing private health fund payments.

The AMA supports the call for change.

“Private health insurance in Australia has traditionally partially funded hospital services, but legislative reforms in 2007 enable health insurers to offer benefits to members for programs that prevent hospitalisation,” AMA (NSW) Vice President Dr Andrew Zuschmann said.

“Interest in expanding private health insurance to primary care services is understandable, given the cuts to Medicare and the growing need for adequate funding for general practice.

“Any expansion of the role of private health insurers would need to be carefully planned to ensure patient care is not compromised.”

While the RACGP did not directly support private health insurers funding services for which Medicare rebates are available, it welcomed discussions with patient groups and the private health sector.

Last year, almost 55 per cent of the Australian population was covered by a general treatment private health insurance policy.

Record numbers of Australians took out private health insurance during the Covid-19 pandemic to avoid delays in essential non-emergency surgery with 14 million now having cover.

Health insurance lobby group Private Healthcare Australia supports the removal of legislative barriers to enable private health insurers to fund primary care programs.

“Allowing health funds to contribute to primary care and prevention will help prevent illness, disease and surgical costs,” PHI CEO Dr Rachel David said.

Originally published as BUPA and NIB call for review of legislation to extend private cover to GPs