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Doctors say Bupa's revised gap cover plan is 'completely inadequate'

Doctors have criticised revised changes to the gap cover scheme of health insurer Bupa, saying it remains "completely inadequate" and should be scotched.

Amid a public backlash, Bupa said it had listened to feedback and tweaked the planned changes to its Medical Gap Scheme so that doctors whose insured patients were admitted into a public hospital for an elective, pre-booked procedure could still access the scheme. Earlier, no public hospital doctor would've been able to use it.

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But the NSW branch of the Australian Medical Association said it remained "frankly outraged" by Bupa's response because the vast majority of procedures in public hospitals were emergency, unplanned ones.

"If I have pneumonia or a fracture out of the blue and I go to a public hospital, I want to be able to choose the specialist who treats me so I can get the best care and Bupa's trying to say, 'We're not going to allow that'," said Professor Brad Frankum, the president of AMA NSW.

"They're saying 'we're not going to use our money, our funds, to support public hospitals'. Well, I'm sorry but it's not their money, it's their members' money, and their members are paying to be able to exercise their right to get the best care delivered by their specialist of choice."

He said Bupa hadn't backed down from its desire to have doctors and patients use its own preferred, contracted facilities.

"This favours people being treated in Bupa-contracted facilities and that behaviour is unconscionable because we need to have a range of facilities that are available to people, that are appropriate to their clinical care, and where doctors choose to do that work should be their choice, not an insurer's choice," he said.

Bupa's gap cover scheme is currently being accessed by doctors in public hospitals so that private patients' medical costs can be reduced or removed.

AMA NSW president Brad Frankum. Photo: WSU

Bupa justified its original decision to remove public hospitals from the scheme by saying the changes would boost transparency and prevent customers from being left with surprise out-of-pocket costs.

On Thursday, Bupa's managing director Dwayne Crombie accused doctors of wanting to "greedily" protect their relatively large earnings.

Bupa's recent announcement have caused public outrage. Photo: Arsineh Houspian

"As Bupa I pay $500 million of my members' money to public hospitals each year, my members pay taxes, how much more are they expected to pay doctors?" he said.

"Also Bupa members can access 96 per cent of private hospital beds without paying out of pocket, and many of the 4 per cent are owned by doctors ... so there's a financial conflict."

Dr Fred Betros, a surgeon from Western Sydney, dismissed Bupa's latest announcement as "lip service", saying the total number of private, elective admissions he had had in a public hospital over the past 12 years could be counted on one hand.

"The majority of admissions is in an emergency scenario and I think Bupa has done this to restore some public faith in them but what they've done is a token offering," said Dr Betros, an AMA NSW councillor.

He said while private patients in a public hospital was a contentious issue, if someone preferred a particular doctor, that was their decision.

"If Bupa's scheme went ahead, 98 per cent of practitioners in the areas I work in would be forced to take a 25 per cent reduction in pay to treat those patients, and those costs would have to be passed onto patients, which would stop them from using their private health insurance in a public setting," he said.

"This drives the standard of healthcare down and it pushes patients down the path of being treated privately on a health fund's terms rather than their own terms."

Bupa has strongly denied that it was moving towards a US-style managed care system, saying the doctor would always be the one who decides which treatment is needed and where it will provided.

"But that's what we're seeing with each incremental change, such as limiting the patient's choice to be treated in a public hospital, and if they want to avoid gaps they have to go to a health fund accredited facility, and it takes away their choice," Dr Betros said.

"Our concern is if patients are caught within this system after August 1 and they wish to change, there may be waiting periods, and what they may decide is, 'Oh well, if we can't change, it's easier to go with what Bupa's suggesting' and go to a Bupa-accredited facility,'" he said. "That's incremental change".