Despite its benign name, ‘managed care’ is the label for an agent (usually in the form of a non-medically qualified manager) to come between the doctor and the patient and dictate/influence what medical treatment will be given to the patient and on what terms. Where it has been implemented in the US, it has driven up costs and completely demoralised a once thriving medical profession. Sir Robert Menzies was so convinced that intervention into the doctor-patient relationship represented an attack on individual freedom, that he introduced an amendment into the Australian Constitution from Opposition, a clause which prevented the government from intervening in the doctor-patient relationship. The Chifley Labor government supported the amendment. Sir Robert Menzies later wrote, “I would hate to see, in my own country, any Government scheme which lowered the importance of the doctor-patient relationship.”

Under the managed care model the patient is disempowered and the doctor works for the insurer, not the patient. Hence a conflict of interest can develop since the doctor’s livelihood is in the hands of the insurer/agent/managed care company, not the patient. Thus there is unnecessary disruption of the doctor-patient relationship and the lines of responsibility that are normally implicit in this relationship become blurred.

Australia has developed an excellent healthcare system with a balance between public and private health sectors and an independent medical profession answerable and legally accountable to patients. We do not want to see the blights of US style managed care introduced into Australia.

Managed care has supporters on both the left and right of Australian politics. The 1995 Lawrence Legislation was Labor’s initiative to introduce “Managed competition” into the Australian healthcare system with some checks and balances. Now, it seems the Federal Government may be willing to hand over parts of the Australian healthcare system to publicly listed health funds. Let’s hope not. The introduction of ‘managed care’ has been the goal of parts of the private health insurance industry going back to 1993 when it clearly stated, “The AHIA [Australian Health Insurance Association] supports the development of managed care initiatives.” Vigilance is required.