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GPs to partner with private health insurers and hospitals

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For the first time, private health insurers will work directly with GPs and hospitals, running programs with the aim of keeping patients healthy.

The Federal Government has announced the winners of the 28 new “primary health networks” which will receive up to $900 million in government funds.

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Health Minister Sussan Ley said the networks, which replace Medicare Locals, would improve frontline services for patients and better coordination between hospitals and GPs.

But Labor’s health spokeswoman Catherine King called it “a deeply disturbing move”.

“This allows private health insurers a direct say in the running of primary care and is the first step towards a two-tiered health system with health insurance members able to jump the queue,” she said.

As ABC News predicted, four out of 28 primary health networks have a private health insurer as part of the winning bid.

• South-eastern NSW has partnered with Peoplecare, a national member-owned, not-for-profit health fund
• Grampians and Barwon south-west in Victoria partnered with GMHBA, a private health insurer
• Brisbane North partnered with HCF and Bupa
• Perth North/Perth South/country WA partnered with HCF and Bupa

In some cases, the groups will be run by consortiums that include universities and hospitals.

Some academics have warned that allowing private health insurers to run training and workplace programs for GPs will create conflicts of interest.

University of New South Wales healthcare expert Gawaine Powell Davies said she was concerned insurers could use their role training and coordinating GP clinics to influence referral practices.

baby in Perth dies of whooping cough
The role of private health insurers in consortiums remains unclear. Photo:  Shutterstock

“My guess is there will be a lot of little slippery slopes and a lot of little back doors that, a year or two down the track, lead to private health insurance taking a bigger role, which is not necessarily good for the community as a whole,” he said.

“Their major commitment has to be to their members.

“However, [as] well intentioned [as] they are to the rest of the community, primary health networks really have to have an eye first on those who have the least good health care and are least likely to be in private health insurance.”

The role of private health insurers in the consortiums remains unclear.

CEO of Brisbane North Medicare Local Abbe Anderson, which will run the new Brisbane North primary health network, told medical press that private health insurers had the same goals – to keep people out of hospital.

But Australian Medical Association spokesman Dr Brian Morton said involving private health insurers in GP care meant the uninsured could lose out.

“The conflict of interest for a private health insurer may be [that] they provide better access to their members,” he said.

“It may be preferential access to services, rather than making it equitable in [terms of] access for every Australian.”

Dr Michael Armitage from the peak body for insurers, Private Health Care Australia, said increased private sector involvement was key to improving quality and consistency in the health system while reducing costs.

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