ADF Newsletter Editorial, June 2016

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ADF Agenda 2016

“The price of liberty for ourselves and our patients is eternal vigilance. Vigilance alone is not enough without involvement.”

Dr Bruce Shepherd AM, Chairman, Australian Doctors’ Fund

Dear Colleagues,

Both major parties have now announced plans to “reform the private health sector” if elected. We have not been told all the details, but we know enough, and some of us have learnt enough to have major concerns. The independence of our profession won’t be a high priority unless we make it one.

Change proposed or imposed by third parties, who have no direct responsibility for patients, should always be examined with the closest scrutiny, and that is one of the reasons why we formed the Australian Doctors’ Fund and why it has been successful over the last 26 years. Every proposal is examined as to whether or not it will be beneficial and effective at strengthening the doctor-patient relationship and improving the ability of our profession to better look after our patients.

Over the years we have seen many inquiries, reviews, reports and proposals that have been nothing morethan attempts to gain greater control over our still independent profession. There seems to be a predilection for importing failed ideas from overseas, as if the NHS or the US managed care system are worth reproducing in Australia.

Our profession has been remarkably successful in meeting the needs of our fellow Australians. This success is based on a strong constitutional statement that the Australian medical profession should not under any circumstances be conscripted to the service of government or commercial interests. Now even this is being questioned.

Hopefully enough of our younger colleagues will heed the call to vigilance and defend the principle of an independent profession, one that is not dependent on government or commercial interests. A positive step is to renew this subscription to the ADF and encourage as many other colleagues to do so. I urge your ongoing financial support of the ADF.

AHPRA Review

The ADF was invited to make a submission to the current Senate enquiry into the medical complaints process. Once again, the ADF outlined the flaws in the AHPRA regulation model. The ADF submission can be found on our website at: www.ausdoctorsfederation.org.au

Website Upgrade

The ADF is pleased to report that our new website is up and running. It contains a large library of academic commentary on health issues in Australia, gathered over 27 years. Thanks to the support of our contributors, this resource is made available free of charge to anyone interested in evidence-based health policy.

ADF Health Headlines

Our ADF Health Headlines format has been upgraded. Health Headlines is available weekly to all members for our annual subscription price of $80.

New Board Appointments

  • Dr Aimee Wiseman (MBBS, Bachelor of Laws (Hons) and Registrar)
  • Dr Farmey Joseph (MBBS, MS (Aeronautical Engineer) MIT and Registrar).

ADF Support for Rural Doctors

Dear Colleagues,

One of the problems with modern communication is that it’s all too easy to avoid meeting with one’s colleagues or even talking to them on a regular basis.

Our ADF weekly teleconferences have been an important support mechanism for myself practising in Coonabarabran. It means a weekly discussion with a number of colleagues across Australia on important health issues.

We are reliably informed on events because every Monday we received the ADF Health Headlines newsletter which details international, national, state and local issues.

Our ADF teleconference guests also add value to understanding what’s going on behind the scenes and more importantly why.

As rural doctors we have the ongoing challenge of ensuring that governments do not neglect constituencies that they may regard as not politically important. Given the pressures on funding for major city public hospitals, it’s often too easy to de-prioritise important improvements that rural doctors need to keep them working in a rural town.

Many of us with experience in rural practice are bewildered by city-centric decisions that ignore the variation in hospital size and patient mix and the resources we have to implement programs.

What seems an excellent idea for a media release can be the most ridiculous suggestion for implementation in a regional or remote hospital.

Just as challenging is the area administration of regional hospitals and the competing interests of various larger centres with a smaller rural town.

One of the initiatives that the ADF will be pursuing is to promote a regular teleconference of rural doctors under its banner. It’s a small step in bringing the profession together. We spend too much time sitting and listening to others who have no idea what our needs are.

Once we had thriving local medical associations to attend and enjoy social contact. Sadly many of these have disappeared. It’s time to reverse the process by coming together across the profession.

Dr Aniello Iannuzzi (Director, ADF)

ADF Rural Doctors Round

To participate in this monthly rural doctors teleconference, please call Stephen at 02 9567 5595

Help Fund the Fund – Download the Newsletter PDF to help support ADF

Where We Stand

Dear Colleagues,

The Australian Doctor’s Fund (ADF) is now in its 27th year. As Directors of the ADF, we are committed to expanding its support base and strengthening its ability to pursue issues that directly impact on our ability as doctors to look after our patients. As doctors, we face a future of growing uncertainty. We can no longer assume that our political leaders will support and defend the traditional role of the Australian medical practitioner.

Our challenge will be to maintain our traditional membership base, and to attract more doctors to support an organisation that is completely devoted to maintaining an independent medical profession thatcan deliver high-quality treatment for all Australians.

It is, therefore, important that the ADF concentrate its resources on some key issues that we believe impede or threaten the doctor-patient relationship and are directly relevant to the work that our colleagues do in the public and private sectors.

Currently we are monitoring the MBS review, proposed changes to private health insurance and the private health sector, the performance of AHPRA, and the constant threat of US or UK style interventions that weaken and distort the doctor-patient relationship.

The ADF is a fire-tower in the forest of competing interests to control our profession. Due to its activity and ability to recognise threats early and organise against them, the ADF has been at the forefront of solutions to the medical indemnity crisis, and resisting the push to establish US style managed-care in Australia.

We have also been able to push back against numerous agendas that have no evidence of making the work of our doctors any more effective. The ADF is an unrepentant critic of naïve and costly empire-building by bureaucrats and others that seek to shape our profession after their own image.

The ADF has also defended and supported oursenior and junior doctors against unfair regulation and procedural unfairness. Our work in this area is ongoing. We have a member of the Australian Medical Students Association (AMSA) and the Australian Senior Active Doctors Association (ASADA) on our ADF Management Committee. We thank you for your continued support.

Dr Farmey Joseph (Finance Director, ADF)

The ADF Supports

Patient choice of doctor and the right to a second opinion. The right of a doctor to independently value their own service and the requirement to provide informed financial consent.

The vital role of the general practitioner, in preliminary diagnosis, referral and independent advice.

A strong private and public hospital sector, maximising their organisational strengths and capabilities.

Practical and sensible medical regulation that supports high standards of medical practice.

Profession led and supported quality assurance and professional development programs which strengthen the medical profession’s desire for continuous improvement.

Strong medical leadership on medical issues.

An affordable national medical register, State Medical Boards with strong medical representation, and a complaints process accountable to a single jurisdiction.

Doctors and health professionals being held legally accountable to their patients in cases of proven negligence.

The ADF Opposes

Forced patient registration, health fund ‘preferred provider’ networks that direct or influence referrals to health fund contracted doctors through incentives or penalties.

Budget holding, capitation, bundled payments, enforced role substitution and schemes designed to bypass the central role of the general practitioner.

Policies that distort the role of the public or private hospital sector for ideological reasons.

Make work schemes and naïve interventions designed to meet political agendas, not professional standards.

The imposition of bureaucratic or third party promoted control mechanisms, fads and marketing schemes disguised asquality control programs.

Using the voice of the medical profession to advance party political agendas.

An AHPRA bureaucracy with no accountability to any single jurisdiction.

No fault schemes which do not provide patients or doctors with due process in cases of alleged negligence.

Challenging the Health Crisis Narrative

Following the election, whoever wins government has announced that it intends to make major changes to private health care. The Coalition will proceed with its Private Health Insurance Review, whilst the ALP will establish a permanent “Australian Healthcare Reform Commission to assist all levels of government to continuously improve our healthcare system.” In addition, a “Centre for Medicare and Healthcare System Innovation” would be established within the Commission to “develop, trial, evaluate and implement new payment and service delivery models that aim to reduce health expenditure while improving the quality and safety of care.”

Australia’s major private health fund lobby Private Healthcare Australia (formerly the Australian Health Insurance Association) claims that:1

  • “Health costs are increasing rapidly”.
  • $100 billion in costs can be cut whilst at the same time “improving health outcomes” (over ten years). PHA goes on to recommend:
  • a “re-mapping of healthcare roles”.
  • removing impediments to “researching best healthcare providers”.
  • increasing the maximum excess level (currently $500 per policy holder)
  • removing the standard default benefit to noncontracted hospitals.
  • removing “the requirement to provide minimum benefits for palliative, rehabilitation and psychiatric care.”
  • addressing the unsustainable benefits paid to public hospitals.
  • removing second tier default benefits from hospitals not located in rural and remote areas, the later to retain “some form of default benefit”.

Coincidentally, a number of media stories have started to appear, quoting various advocates, who support the out of control cost narrative, and the need to empower health funds to deal with it, including making changes to the anticonscription provisions of the Australian constitution.

At the same time, the Members Own Health Funds (MOHF) have launched a public campaign, with reports that “the “big three” companies … are fuelling affordability concerns while also enjoying rising profits.”2 Close on their heels is the CEO of Hirmaa, a group of 19 not-for-profit member funds, that their CEO Matthew Koce claims “are growing at twice the pace of the bigger for-profit insurers and are retaining far more policy holders with an average member retention rate of 90% for the period 2011-15.” He also claims that “complaints against the country’s for-profit insurers increased by more than 90% while complaints against Hirmaa member funds fell by 8% from 2011-14.”

The ADF has examined the statistics on health costs produced by the Australian Institute of Health and Welfare (AIHW)3 and the Parliamentary Library which shows:

  • Health inflation was less than general inflation by 0.77 from 2003/04 to 2013/14,
  • The increase in private health insurance premiums in 2016 was lower than 9 of the previous 13 years,
  • The amount of health spending by health funds was reasonably steady at around 8% of total healthcare spending.
  • The proportion of health spending by individuals (not including health funds) has remained almost constant since 2003 at around 17.3% of total healthcare spending.

The narrative that Australia’s health costs are out of control does not seem to fit with the evidence. What does seem to fit is that Australians (as with other advanced countries) have a strong demand for quality healthcare, which governments have promised to fund and subsidise. No amount of remapping of healthcare roles will overcome this reality.

Stephen Milgate, (CEO & Director, ADF)


  1. Private Healthcare Australia, Submission: Private Health Insurance Consultations, 4 December 2015, http://www. privatehealthcareaustralia.org.au/private-health-insuranceconsultations-2015-16/
  2. Sarah-Jane Tasker, “MOHF to tackle health funds nib, Bupa, Medibank”, The Australian, 18 May 2016
  3. AIHW, Health expenditure Australia 2013-14, 2015
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