Fairness within the health sector of Australia is fast becoming a focal point within the health practice landscape.
Recently, the ADA (Australian Dental Association) launched a petition to bring Parliament attention towards ending discriminatory rebates within the dental industry. More specifically, the ADA is talking about dental preferred-provider platforms.
What is a preferred provider?
The most expansive and numerous preferred provider platforms are hosted by Australia’s biggest health insurers. Medibank has the Member’s Choice network, BUPA has the Member’s First network, HCF has the More For You program (with specific names for each industry, for example: More for Teeth in dental), and HBF, AHM by Medibank, and NIB, all have specified preferred health providers in multiple locations.
Preferred provider platforms are networks of health practices and providers who offer higher returns for health services when claimed through a particular health fund. The benefit for the health insurer is that they can reduce and better control outgoing benefit claims claims for services such as dental, physiotherapy or chiropractic. The benefit for the participating practice comes from a marketing perspective: being an advertised preferred provider means new patients coming through the door. Finally, the benefit for the policy-holder is that they have a lower gap to pay when they claim for said health services.
It all sounds like a win-win-win on the surface but – like all things – something has to give. The true cost behind the scenes could be perceived as being more sinister. We’ve heard several stories of some practices building their entire patient-base and business model around big health funds preferred-provider platforms just to have their contract rejected when they changed business locations (or for other reasons). In one terrible move, potentially more than half of their patient base became at high-risk of moving to a competitor preferred-provider within proximity (sometimes, even, with assistance from the big health funds customer service team or online provider search tools).
Who wears the cost of these preferred provider platforms? Upon investigation, we found that the hosting health insurer dictates the frequency and fees of several item numbered services. It all comes down to cost control so that these big health funds can avoid significant prices hikes in April each year – it makes sense on paper. The cost of health insurance is a big issue of late and we understand the mathematics behind benefits paid as a percent of contributions, however, skewing the market and penalizing independent health practice should not be a welcome practice in Australia.
Freedom to choose. Fairness by choice.
The biggest threat that preferred provider programs bring to our community is in relation to freedom and fairness. It threatens our freedom to choose who we attend for important health services and treatments without being penalized. It severely wounds independent health practice in Australia by shepherding insured Australians to practices in contract with certain health insurers, creating a biased and ultimately unfair landscape of choice. Remember, over 80% of insured Australians are with the top five largest health insurers, all of which host Australia most prominent preferred provider platforms.
This is a major issue of retention for independent health practitioners. Through no fault of their own, honest Australian businesses are losing patients to competitors who are in bed with particular health funds. To remain independent, these practices are being forced into a scenario where some patients incur huge out-of-pocket gaps for their treatment simply because the opt not to participate as a preferred provider (or perhaps were rejected participation). Poor rebates can negatively affect overall attendance and repeat business from customers, especially for preventative and ongoing health services. If the service costs the customer too much, they just don’t come back as often – it becomes a grudge service.
In this common scenario, the patient is being forced to choose between lucrative health fund rebates and their own right to choose who they attend for treatment. We’ve spoken to countless people who come to us for help because they’ve been attending their trusted health professional for years and more and don’t want to have to change just because their fund pays more somewhere else. It’s just bad news all round for independent health practice.
This issue of an uneven playing field isn’t just limited to claimable extras service such as dental. A patient can find themselves incurring significant out-of-pocket expenses associated with in-patient services and surgery too. BUPA made more than a few headlines in 2018 for trying to establish a restricted list of approved hospitals and doctors. Australians need to understand the true threat that this approach to cost-control can impose onto our freedom of choice.
The crux of our service is helping people compare health funds with private health insurance companies that use minimal or no preferred provider platforms. By minimal, we mean severely limited to a small handful of locations, most often hosted within or around the health insurers home town, and certainly not prominent in greater Australia.
Fair Health Care Alliance approves the following private health funds
Here is a list of health funds in Australia who we think fit our criteria for being fair and who encourage non-discriminatory choice of provider for health services. Please note that some of these funds have very minimal preferred providers, which we have detailed below the table.
|CUA||LaTrobe||Queensland Country Health|
|Doctors Health||Mildura||RT Health|
|Emergency Services||Onemedifund||St Lukes|
|GU Health||Navy Health||Teachers Health **|
|HIF||Nurses & Midwives **||Transport Health|
|Health Partners *||Peoplecare||TUH|
* Health Partners qualify for this list outside of Adelaide only. Health Partners have several preferred providers in Adelaide and the Barossa Valley.
** Teachers Health Fund, Nurses & Midwives and Unihealth have five health centres total in Surry Hills NSW, Parramatta NSW, Hamilton NSW, Richmond VIC, and Adelaida SA.
Support these health funds – Get a quote
You can support the health funds listed above by considering them in your next health insurance comparison quote. By doing so, you are drawing a line in the sand and making a strong statement: that all Australians should have complete and total freedom in choosing their own health providers, and that they should receive fair rebates from their insurer despite who or where they choose to attend for treatment.
We are able to organize a formal comparison quote with some of these approved health funds. We do not work with all of them, although, we would certainly like to given the opportunity. We will help you compare any policies with health funds that might interest you side-by-side against the health fund you may be currently with.