Call for a Private Health Authority referred to Health Minister

Calls for the Australian Government to establish a private health commission or independent authority are now sitting in the in-tray of Minister for Health, Hon Mark Butler MP.

The Australian Society of Ophthalmologists (ASO) launched an e-petition via the Parliament of Australia website in late 2024, requesting the establishment of a private health commission — or independent private health authority — to restore balance to the divided and failing sector.

ASO Chief Executive Officer, Katrina Ronne, said the survey attracted 268 signatures and met the e-petition requirements to be referred to a Minister for response.

“We received confirmation from the Petitions Committee that our signature was presented in the House of Representatives and referred to the Minister for Health, Hon Mark Butler MP, for response within 90 days,” Ms Ronne said.

“With an election looming, we are eagerly awaiting his response, which we hope outlines sound reasoning for or against the establishment of a private health commission or independent authority.

“To date, similar requests have been referred to the Private Health CEO Forum, but without indication of strong support from the Minister for Health.

“We are asking Minister Butler to step up and show leadership and fortitude to find solutions for all Australians, as opposed to sitting on the sidelines and simply watching on or deferring to the Government’s closed Private Health CEO Forum.”

ASO President, Dr Peter Sumich, said the Society was among many health bodies voicing concerns for the failing private health sector and the reach of the private health insurance industry to gain more control over patient decision making and costs. 

“As private hospitals continue to close and go under, we are seeing a shift towards the vertical integration of private health insurers into such hospitals,” Dr Sumich said.

“This is not a long-term solution that favours the best interests of Australian patients and their families.

“Instead, it is the beginning of an inevitable transition to US-style Managed Care, where the private health insurance industry stands to reap profits and overrule clinical and patient decision making against the recommendations of clinicians and the requests of patients. 

“We need balance and regulation — which a private health commission or independent authority can provide — to ensure fair and reasonable distribution of power.”

The ASO said one only needs to look to the United States to see what the future could be, should a creep towards managed care continue. 

In one example, a surgeon recounts that she was in the middle of operating on a breast cancer patient when a call comes in from the private health insurer, requesting she call them “right now” about said patient.

The insurer then questions the surgeon as to whether the patient’s inpatient day is justified to be covered by insurance, despite it previously being approved. 

In another example, a young father and husband is battling bile duct cancer and needs a liver transplant, if he has any chance of survival. His doctors are ready, his body is ready, and his living donor is ready.

The private health insurer declined coverage for the procedure, deeming it ‘not medically necessary’ and noting in its rejection letter, “Medical studies do not show that this surgery will improve your short or long term health” — counting him as already deceased. 

“We hear reports out of the US that health insurers are blamed for numerous deaths each year, as a result of rejecting procedures and treatments they deem ‘not medically necessary’,” said Dr Sumich.

“In December, we saw this result in the assassination of the Chief Executive Officer of the largest health insurer in the US, based on the number of its members and physicians employed.

“This is not a future we want for Australians,” he said.

Any loss or compromise to the effectiveness of the private hospital sector in Australia will increase demands on an already struggling public health system.

“That is why this is an issue that affects all Australians — whether you have private health coverage or not,” he said.

Ms Ronne encourages ophthalmologists and broader members of the community to make their concerns heard this election.

“Support the calls to action being made by your ASO, the AMA, and other health industry bodies by raising the issue with your local member or candidate running this federal election,” she said.

“If we all do our part, we can ensure Canberra hears us and is forced to act before it is too late.”

To understand more about the role a private health commission or independent authority could provide to the failing private health sector in Australia, click here.