Concerns rise over fragmentation and disparity of care as private health insurers expand services

Medical: Fragmentation of patient care and the widening gap of equitable access to healthcare remain key concerns as private health insurers expand services.

Health insurer Bupa has launched a trial scheme offering three free virtual GP visits annually to around 1 million customers with extras cover. Concurrently, Medibank has extended its mental health support services to its health insurance customers, including those with Extras and ambulance cover.

However, Dr Nicole Higgins, President of the Royal Australian College of General Practitioners (RACGP) voiced concerns about the potential for these initiatives to create disparities in care.

“General practice care must be universal. The last thing we want is a two-tier healthcare system that leads to some people receiving superior care, and others missing out. No patients should be left behind and unable to access care, irrespective of postcode or income,” Dr Higgins told Health Industry Hub.

Elizabeth Deveny, CEO of Consumers Health Forum of Australia, echoed these concerns.

“Australians all want everyone to get a fair go with their healthcare and don’t want these divides to deepen and continue to grow,” Deveny said. “My question would be what pressure is being taken off by up to three visits from a GP. Doesn’t seem like a lot of pressure in the system more broadly.”

Bupa’s program required special approval from the federal Health Department, as current laws prohibit private insurers from covering out-of-hospital medical services like GP visits and certain diagnostic tests.

Dr Higgins further elaborated on the need for a more sustainable solution, saying, “Patients can make their own decisions about their private health insurance coverage and what works best for them, including telehealth consults with a GP.

“However, this is not a sustainable, long-term solution to resolving issues concerning access to general practice care. We need greater investment in general practice care and measures to boost the GP workforce, including incentives to encourage more future doctors to become GPs.”

During a recent Post-Budget meeting, Shadow Health Minister Senator Anne Ruston highlighted the urgent need for improved primary care accessibility, referencing the 1.2 million Australians who avoided seeing their GP last year due to financial constraints.

“What struck me most was that the Budget didn’t have any real seamanship pieces to address the challenges that are before us, including…. access to primary care – because every other sector gets pressure put on it when primary care isn’t working,” Senator Ruston remarked.

Despite criticisms from key stakeholders, private insurers argue that these new services are enhancing care accessibility. Medibank’s Chief Customer Officer, Milosh Milisavljevic, stated that expanding its 24/7 nurse and mental health support lines would benefit an additional 700,000 customers.

“Having access to health support at any time of the day or night is a valuable resource for our customers and will potentially help them avoid unnecessary trips to their GP or emergency department. This support will also be welcome in regional and rural areas where access to health services can be more limited,” Milisavljevic said.

Bupa’s Dr Simon Benson highlighted the financial relief these services could provide.

“We do worry and like to look for areas where we can provide value,” Dr Benson said. “By providing these set number of sessions with zero out of pocket, we’re also supporting our members at a time where cost of living is high.”

Dr Higgins emphasised the importance of avoiding fragmentation, asserting, “Continuity of care is vital, particularly for patients managing multiple, chronic conditions. So, we would expect that Bupa send any consultation notes or outcomes to the patient’s regular GP to maintain a comprehensive record.”

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