The risk and rise of health insurer ‘managed care’ in Australia

Last week The Australian exclusively broadcast that national health insurers were failing to meet a gold standard target of returning 90% of premiums to their members.

As a surgeon, I see first-hand the effects upon my patients, especially as the cost of living continues to rise and everyday Australians are being financially stretched to their limits. One high-profile health insurer returns only $201 to my patients undergoing a cataract operation and doesn’t even have a gap cover scheme.

Perhaps more concerning, is the creep towards health insurer ‘managed care’ within Australia — an issue largely overlooked, poorly understood and developing insidiously.  

Patients must be protected from health insurers making contracts which compel or financially induce doctors to follow their (insurer) treatment rules, and from vertically integrating hospitals to dictate or enforce treatment pipelines.

We need our government to establish an independent private health regulator and protective legislation to ensure that patients are aware of their options and the alternatives before accepting binding healthcare contracts made between their insurer and the hospital.

Our campaign ‘send the eagle home’ attempts to address the public gap in education around these issues.

— Dr Peter Sumich, President of the Australian Society of Ophthalmologists