‘Conflict of interest’: AMA cries foul over Bupa’s mental health expansion
Health funds have denied accusations by the country’s peak medical body of threatening the autonomy of the health system by expanding into clinics and service offerings.
The Australian Medical Association has been accused of “fearmongering” after fighting Bupa’s expansion into mental health care amid a broader shift by health funds into service provision.
The feud between doctors and health funds presents a new challenge as stakeholders move to modernise Australian healthcare without muddying the boundaries between insurers and service providers to the detriment of patients, with the AMA urging the Albanese government to legislate against health funds investing in clinics.
Bupa said on Monday it would create 60 mental health clinics by 2027, building on a prior announcement to bankroll 130 medical centres. The British-owned health insurance major made clear last year it would expand out from its current primary care service offerings of dental, optical and aural care, providing a new frontier for profit in lieu of uncapped insurance premium rises.
The ‘Mindplace’ clinics will roll out from this month, with ten to operate by year’s end.
The AMA said Bupa’s growing stake in health service provision pointed to the rise of a “US-style system of vertically integrated managed care” in Australia and presented a conflict of interest.
“We are concerned Australia is hurtling towards a US-style system of vertically integrated managed care, where health funds have too much say over the clinical care that patients receive,” AMA president Danielle McMullen said.
“It is crucial that we avoid a scenario where profits are put before patients, like we have seen happen in the US with disastrous results. Clinical decisions must remain in the hands of doctors and their patients — not influenced by insurers or corporate ownership — so that care is guided by need, not by financial incentives.”
“The conflict of interest in an insurer both funding and delivering care is incredibly obvious — and while these insurers will use spin to explain away these concerns, it is vital the new government moves quickly to address this, including through the establishment of a private health system authority to oversee the sector.
“Patients should be very worried when private health insurers are setting up an environment where they are potentially able to access more information than ever before about a patient’s health and interfere with decisions that should be made by a patient after talking with their doctor in the safety of a private consultation.”
Bupa argued its service expansion would provide more options to patients, rather than being constrictive.
“We believe our role in healthcare provisioning is to increase access to preventive and primary care services,” Bupa Asia-Pacific chief executive Nick Stone said.
“By investing in primary care, we aim to create better access to high-quality healthcare for the whole community. This makes sense as it takes pressure off the system as a whole and helps keep patients healthier, earlier.
“By launching an extensive network of Mindplace mental health clinics, Bupa intends to play a pivotal role in meeting the ballooning demand for mental health support in our community. Our ambition is to work in partnership with the services already provided by the public system to ensure all Australians can access the mental health support they need.”
Private Health Australia chief executive Rachel David argued the AMA was deploying a well-worn yet illogical argument, saying legal provisions on the big four were sufficient to protect patient autonomy.
“There is nothing in the Australian health system that resembles the US health system, and the protections against going down that path go all the way to the Constitution,” she said. “It’s absolutely fearmongering.
“This issue about US-style care has been raised by the AMA for decades, and it can’t happen, and it’s never happened.
“It really is not encroaching on anything that should be alarming the AMA in any way.
“There are really strict provisions by the medical boards and other regulators against health funds being involved in clinical decision making in any way. Health funds can’t directly employ private doctors, nor can they determine what they charge.
The Albanese government has repeatedly made it clear it wishes to keep its hands clean of disputes between private health providers and insurers, though it threatened regulatory action against funds in March if they failed to fork out more to struggling private hospitals after rounds of brinkmanship boiled over into public disputes that threatened service access.
More Coverage
To join the conversation, please log in. Don't have an account? Register
Join the conversation, you are commenting as Logout