From AMA (NSW) President Prof Brad Frankum As you may be aware, last week, BUPA advised policy holders and practices of significant changes to their insurance policies. These changes were introduced without consultation with the AMA or any other relevant stakeholder in the health sector. The changes also have the potential to have a significant impact on the delivery of healthcare in Australia. Besides the proposed changes to levels of cover (effective from July 1st), there are changes relating to the "no gap" and "known gap" schemes (effective from August 1st) that could result in the following implications for patients holding BUPA insurance: Doctors providing services to BUPA-insured, private patients in public hospitals would no longer be able to access gap scheme payments for those patients. Doctors providing services in private facilities not contracted to BUPA, will also be unable to access gap scheme payments for their BUPA patients. After August 1st, BUPA patients who wish to be treated in a non-BUPA facility may face waiting periods, if they then decide to try and change health funds, with the result that they are more likely to be directed into BUPA-approved facilities instead of changing health funds. All of the above is essentially the start of facility-based, managed care and represents a significant reduction in entitlements and benefits for our patients. For VMOs in public hospitals, we know that while the VMO Determination allows VMOs to set their own private patient fees, many VMOs have chosen to accept a no gap payment for private patients in public hospitals. We understand that the BUPA arrangement is likely to significantly impact on that decision when admitting and treating BUPA-insured private patients. It should also be made clear, that for all other private health funds, none of these changes will apply. Both Federal AMA and AMA (NSW) are working very hard to reverse this decision by BUPA. This is because we primarily strive to maintain the long-held belief that, in Australia, it is a patient’s choice of which doctor they see and where they are to be treated, without the external influences of the private health insurance industry. Until a reversal of this poor decision on the part of BUPA can be achieved, we would advise you to make sure your BUPA-insured patients are fully aware of the implications that staying with their insurer may have upon them and their families. If a patient wishes to change their insurer, under the Private Health Insurance legislation, the rules of portability will allow them to do so without undergoing further waiting periods. After August 1st, however, if a BUPA patient chooses to change funds, there will potentially be waiting periods to serve regarding gap scheme payments at certain hospitals.