Patients to shop for docs

PATIENTS would be encouraged to shop around for specialist doctors with “open referrals” from their GPs, under a proposal to put downward pressure on out-ofpocket medical expenses.

Private health insurer Bupa has challenged the practice where a GPs refers a patient to a specialist. The fund argues an “open referral” would make it easier for a patient to choose his or her specialist based on cost and other considerations.

Bupa health insurance managing director Dwayne Crombie will make a series of recommendations on how to reduce out-of-pocket costs for patients when he appears before a Senate committee inquiry this week.

“To further improve customer choice, the Government should work with the specialists and peak bodies to facilitate the widespread use and understanding of ‘open referrals’ that customers can take to the specialist of their choice,’’ Bupa said in its submission.

“Having access to an open referral process would enable patients to act on information regarding costs and possible consequences.”

Australian Medical Association federal president Michael Gannon said patients could already choose to attend a specialist other then the one recommended by their GP.

“The patient is absolutely entitled to exercise choice on that,’’ Dr Gannon said.

However, he said GPs were often able to recommend to a patient which specific specialist would be best for them.

“GPs are often well placed to understand different personalities for different people and certainly a good GP would . . . work out what might be best for each patient,’’ he said.

Some patients with private health insurance are reluctant to use it because of fears they could be liable for “gap payments” that were not covered by insurance or Medicare.

Dr Gannon said 89 per cent of surgical procedures were performed without the need for patients to pay a gap and another 6 per cent had a “known gap” of less than $500.

Patient group Consumers Health Forum wants reforms to make it easier for patients to estimate the out-of-pocket costs for surgery performed in private hospitals.

Patients often have to seek separate estimates from the lead surgeon, the anaesthetist and other members of their medical team.

It told the Senate inquiry a single quote should be prepared by the leading specialist on behalf of the team.

“The surgeon picks the team and so it shouldn’t be unreasonable to suggest that his/her practice management should take responsibility for getting the quotes,’’ the Consumers Health Forum submission said.

The Government this month announced a range of measures to reduce private health insurance premiums.