Commentary on the private practice implications of the Deed of Settlement in the Honeysuckle Health – NIB Australian-Competition-Tribunal-hearing

Abstract

Objective To provide a commentary on the implications of the Deed of Settlement in the Honeysuckle Health – nib Australian-Competition-Tribunal Hearing. This hearing has major implications in relation to the potential for a single dominant private-health-insurance buying-group to contract for medical-purchaser-provider-agreements that might limit the clinical autonomy of patients and psychiatrists. Conclusions The Australian Competition and Consumer Commission (ACCC) authorised the formation of a joint buying-group for private-health-insurers in 2021 to provide collective contracting and related services to private-health-insurers and other healthcare-payers. A consequent legal challenge resulted in a Deed of Settlement on 18 July 2022 that for 5 years preserves doctor-patient autonomy in clinical decision-making, the medical gaps scheme, the transparency of contractual arrangements, and if clinical data of those insured are collected by HH-nib, it must be with the full informed consent of patients. However, there remain options for private-health-insurers to apply for formation of new buying-groups, as well as to collect data and profile the general public and insured patients using online programs. Vigilance on private-health-insurer buying-groups, and the potential for US-style managed-care is warranted.

Kintsugi: Comprehensive repair of Australia’s fractured psychiatric care system

“…Vigilance is also warranted with the potential bracket creep of private health insurance (PHI) providers to provide parallel outpatient and private psychiatric services in the form of US-style managed care. 14 The formation of a buying group to purchase medical services by a PHI consortium, the consequent challenge in the Australian Competition Tribunal, and the Deed of Settlement has demonstrated the potential perils of managed care through selective contracting, limiting choice of treatment, and gatekeeping to limit healthcare use. 14 Limitation of private psychiatric services could lead to increased public sector demand.…”

“… 14 The formation of a buying group to purchase medical services by a PHI consortium, the consequent challenge in the Australian Competition Tribunal, and the Deed of Settlement has demonstrated the potential perils of managed care through selective contracting, limiting choice of treatment, and gatekeeping to limit healthcare use. 14 Limitation of private psychiatric services could lead to increased public sector demand.…”

Health economics-informed planning of psychiatric care: A primer and curriculum framework for psychiatrists

“…However, the subsequent deed of settlement at the Australian Competition Tribunal demonstrated the danger of financial control being consolidated in the private healthcare sector. 12 This could lead to managed care involving selective contracting, financial incentives and penalties for doctors, and limitations on patient use of healthcare. 13 Health economics could therefore assist private psychiatrists in understanding the benefits, and especially costs of such a wide-ranging development.…”