Patients deserve full disclosure on costs

INFORMED Financial Consent (IFC) for patients is essential. Private hospitals are already the most compliant actor in this space. So when bringing others to a suitable standard, care must be taken not to penalise those already doing the right thing.

The Australian Private Hospitals Association's response to the key questions raised in the federal government's consultation on making IFC legally enforceable, are overwhelmingly positive.

"We support making IFC for patients legally enforceable, provided any obligation is clear, proportionate, and limited to fees or information within the provider's control," APHA CEO Brett Heffernan said.

"The obligations must attach to the provider responsible for the relevant charge, and should not make hospitals responsible for estimating, verifying or guaranteeing fees charged by independent practitioners or benefits calculated by insurers.

"Private hospitals already provide written information about accommodation, theatre, prostheses and other facility-related charges under the existing private health insurance framework. The main gaps in IFC generally arise where patients receive separate bills from independent medical practitioners, anaesthetists, pathology, radiology or other providers, or where accurate insurer benefit information is not available at the point of consent.

"We support penalties for those who fail to comply, where a provider fails to disclose fees or information that are within their control. Penalties should be proportionate and should not apply to hospitals in relation to third-party practitioner charges, pathology or radiology fees, or private health insurer benefit information that hospitals cannot independently verify.

"Explicit recognition that private hospitals are already the most-regulated and most-compliant IFC actor is necessary. Without this, reform risks inadvertently re-regulating facilities that already meet a high standard."

The APHA asserts there needs to be:

• A clear distinction between facility charges and practitioner fees. Facility charges are predictable and hospitals quote them accurately today; practitioner fees are variable and are the actual driver of bill shock. Reform design should treat the two differently.
• The health insurers have a role in enabling accurate estimates. The inability to produce a reliable patient gap figure at the point of consent is a system data failure, not a provider failure. The paper should address insurers' obligations to provide timely, accurate benefit information.
• Consistency with second tier eligibility and risk-equalisation arrangements must be addressed. Existing hospital IFC obligations operate within the private health insurance framework, including second tier eligibility settings. Any new obligation should be designed consistently with that architecture, so reform does not create conflicting requirements or duplicate obligations for hospitals.
• A dedicated regulatory-burden and cost-impact assessment is needed for private hospitals, including smaller, regional and rural operators, before any new obligation is imposed.
• Cost recovery. Hospitals should not bear unfunded compliance costs in pursuit of a systemwide transparency objective. This would be materially unfair.

"The APHA supports reforms that improve patients' understanding of the likely costs of private healthcare, but reforms must be targeted to the source of the problem and avoid duplicating obligations already imposed on private hospitals and who already meet their obligations," Mr Heffernan added.

"Reform should, therefore, focus on improving practitioner disclosure, insurer data transparency and system-wide digital infrastructure, rather than imposing additional compliance obligations on hospitals that do not control those fees."

-ENDS-

The APHA's submission is available at: Informed Financial Consent Response.

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