How will Medibank Private’s actions affect care for my patients? What is Medibank Private Doing? Medibank Private is using its size and market power to unilaterally impose measures on private hospitals that mean nothing in the health care sector and will not improve the safety and quality of care of patients. The fund has developed a list of 165 "highly preventable adverse events" which it will not pay for. This list was created in isolation by Medibank and has no standing in the healthcare sector. It is not based on accepted clinical standards, has not been validated by any safety and quality body and the consensus of the medical profession is that they do not support the use of this list. In addition, Medibank Private is seeking to impose penalties in certain circumstances involving complications or readmission within 28 days which will inevitably see access restricted particularly for the chronically ill and those at the end of life. Why are hospitals opposed to Medibank’s proposals? Medibank’s tactics are focused on increasing their shareholder’s return and are not based on evidence of improvement of safety or quality. These tactics will impact harshly on Medibank Private members who are aged, vulnerable, chronically ill and those at the end of their life. This is an example of insurers dictating how private hospitals and doctors should provide medical care to their patients, the very definition of managed care. We do not agree with Medibank’s approach which infers that quality is not up to standard in private hospitals when all the evidence shows that we do in fact have a very high standard in this country. Hospitals are not opposed to quality measures in contracts with health funds provided they are:  Based on evidence  Likely to lead to improvements in healthcare delivery  Relate to risks that hospitals can manage. None of Medibank’s measures fit these criteria. What are hospitals and doctors doing? Private hospitals are committed to safety and quality and recognise the need to continually monitor and improve quality and performance for patients. We are working with the medical profession and the Australian Commission on Safety and Quality in Healthcare (ACSQHC) to reach a consensus on agreed quality indicators that can lead to improved outcomes. We are urging all health funds, including Medibank, to join us in this endeavour. What can you do?  Inform your patients who are Medibank Private members about this issue (we have developed a fact sheet for you to use entitled How Do Medibank Private’s Actions Impact My Healthcare?)  If patients wish to switch to another health fund, ensure they know they can do so without penalty. They can find out more at http://www.phio.org.au/downloads/file/PublicationItems/RightToChange.pdf Level 3 /11 National Circ, Barton ACT 2600. PO Box 7426, Canberra BC ACT 2600. [T] 02 6273 9000 [F] 02 6273 7000
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