Dr Michael Vagg, a physician in Victoria, has been reading up on Medicare Select. And he’s found more questions than answers.

He writes:

“Having made a brave effort to decode the relevant documents, I am completely unclear about the role of clinicians in the Medicare Select model.

While the National Health and Hospitals Reform Commission happily burbles away about levers, silos and USOs, the smell of a highly sugar-coated confection of managed care and consumerist ideology begins to waft under my nostrils.

While the background analysis document from the Parliamentary Library, authored by Dr Anne-marie Boxall admits frankly that “it is highly probable that plans would implement some forms of managed care in an effort to control costs under Medicare Select” the mere mention of that phrase is absent in the Commission’s report, and the rather important discussion of what the risks of implementing such a sweeping reform may be simply does not occur.

There is no mention of what happens to the public hospital clinicians currently employed by the States to staff the public hospitals.

The potential clearly exists that differences could occur between negotiated arrangements of various plans which might mean that all four patients in a four-bed ward of a public hospital may get different treatment for the same conditions.

Emergency Department staff would have to be sure of the details of an individual’s plan before initiating treatments which may not be covered by that plan.

Would Australian ‘health and hospital plans’ be allowed to demand the onerous and frequently clinically inappropriate ‘pre-certification’ or pre-approval procedures beloved of American HMOs?

These procedures demand a clairvoyant ability to know when and how one is going to get sick and need emergency care if away from home or even in a different part of the city, in some cases.

If the ‘plans’ are going to pay for all the services connected with public hospitals, who will fund the non-clinical time of clinicians which is more than used up supervising training, teaching medical students, doing paperwork and even, heaven forbid, wasting valuable time reading journals and discussing the literature with colleagues ? (I am well aware that this last notion is fanciful and will raise a derisory snort from most public hospital clinicians.)

Much, much more detail will be needed on this proposal which has the look of great back-of-the-envelope idea but which will demand an extraordinary amount of thinking through to foresee the likely implications of moving all public health care to a funding model based simply on clinical fee-for-service.”

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