Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

LETTERS TO THE EDITOR

LETTERS TO THE EDITOR COMMUNITY HEALTH STUDIES VOLUME W, NUMBER 4, 1990 LE‘lTERS TO THE EDITOR Sir private patients in public hospitals triggered the so- The paper ‘From Medibank to Medicare: trends called ‘Section 17 dispute’ which led some specialist in Australian medical care costs and use from 1976 groups in New South Wales to withdraw their to 1986’ by Moms Barer, Mary Nicoll, Mark services in 1984. As a result, in 1984 the Commonwealth Govern- Diesendorf and Roy Hantey (Community Health ment established the Committee of Inquiry into Sfud 1990; 14: 8-18) contains a serious flaw. The paper reports a statistical analysis of chan- Rights of Private Practice in Public Hospitals, with ges in the volume and costs of private medical care Professor David Penington as chairman. The other in Australia between 1976 and 1986 undertaken by members of the committee were Dr Brendon officers in the Australian Institute of Health. Kearney of Adelaide and me. The committee Reports of the analysis are also appearing other functioned for six months and dealt with many publications. The study purports to show changes in issues. It delivered its Final report in September per capita utilisation, costs and mix of ‘private’ 1984. medical services (i.e. those for which medical One issue related to the assertion that services in radiology and pathology had increased dispropor- benefits were payable) between April - September tionately higher than other services, based on half-years of 1976 (under Medibank) and 1986 (under Medicare). figures from the Commonwealth Department of For much of 1975-76 (and during the six Health showing payments to patients for ‘private’ months the study selected for 1976), Medibank examinations. The committee demonstrated quite arrangements prevented the payment of benefits for conclusively that the assertion bore no relationship diagnostic services to in-patients classified as to the facts and resulted from an error in taking ‘private’ in public hospitals. Hence radiology and 1975 -76 as the base year. pathology services provided to these patients In its Final report the Penington Committee escaped the count of medical services provided to recorded (page Al) that the situation ‘had the ‘private’ patients in this period., Other medical effect of significantly reducing total claims for services were unaffected by the situation. Benefits Medical Benefits for Pathology and Radiology services in that year’. Pages 44-51 and Annexure for these diagnostic services are payable under Medicare. 1 are particularly pertinent to the committee’s Not surprisingly, therefore, increases in pathol- analysis. I quote one sentence (from p. 51): ogy and radiology sewices appear to be dispropor- Growth in utilization (since 1975/76) as shown tionately higher when numbers and costs of private in the Medical Benefits data therefore reflects medical services rendered in later years are com- redistribution of services from the public to the pared with private medical services provided in private sector. 1975 - 76. Although the paper published in Community The authors are either unaware of the Penington Health Studies acknowledges that Medibank did not Inquiry and its report or have chosen to reject its permit public hospitals to charge private patients findings. It is strange, whichever is the case. If they are unaware of the report, their credibility is in for diagnostic services, its calculations make no question. Alternatively, if they reject the report’s allowance for that fact. Thus the study seriously Overstates the rate of increase in the volume, cost data and conclusions on radiology and pathology and mix of ‘private’ radiology and pathology ser- services, they have done so without producing new evidence or refuting the committee’s evidence. In vices provided to the population per capita since fact, the authors would be unique in being the first then. Medibank’s arrangements for the provision of in six years to challenge the data which, though unpalatable, were accepted by Dr Neal Blewett and medical services, particularly diagnostic services, to VOLUME XIV, NUMBER 4,1990 428 COMMUNITY HEALTH STUDIES Dr John Deeble. period, prior to 1984, for which there are data Further, confidential information has been made thatare broadly comparable with post-1984 data. In reporting the study we indicated the difficulties and available to me recently by companies which supply dangers in making comparisons between two similar x-ray fh. It shows that the area of doublesided but not identical universal health insurance systems emulsion fh, as is used for items in Part 8 of the and Over a period when there were significant Medicare Benefits Schedule, sold per head of changes in the health insurance systems. population has declined slowly and progressively One of the differences between the two schemes, from 1983 to 1989. This fact is not compatible with a si@icant increase in Part 8 radiological examin- as Dr Cashman correctly points out, was the e@- ations. bility for reimbursement of fees for diagnostic I am concerned that the flawed interpretation of services provided to private patients in public data in the Australian Institute of Health study will hospitals. In 1976 under Medibank, fees were not charged for such services and therefore were not fuel misunderstanding between the medical profes- counted as private medical services, but in 1986 sion on the one hand and the Government and the Department of Community Services and Health on under Medicare, fees were eligible and included. the other if they take the study at face value and We were aware of the change and undertook some analysis to identlfy the magnitude of the effect. On act on its contents. the basis of available data it was estimated that in 1985-86 about 8 per cent and in 1986-87 about DrLD. Carhman 12.5 per cent of pathology services reimbursed Macquarie Street under Medicare were provided by hospitals. Adjust- August 1990 Sydney ing for this would reduce the level of increase in pathology services. However, it remains substantial. The change in respect of private patient diagnos- tic services was of course only one of a number of Sir changes that took place in the health care system Dr Cashman claims that the study undertaken by during the period examined, including restructuring the Australian Institute of Health concerning the of the pathology schedule in 1977. Some of the changes in use and costs of private medical care in changes may have had the opposite effect and the period 1976 to 1986 contains a serious flaw. shown reduced utilisation levels. If an adjustment The study has been reported in ‘From Medibank were to be made for one change, it would need to to Medicare: trends in Australian medical care costs be made for all changes and across all medical ser- and use from 1976 to 1986’ (Communiry Health vices. As the Penington Committee acknowledged, Stud 1990; 14: 8-18), ‘Changes in private medical the data needed to make such adjustments across service use, 1976 to 1986’ in Economics and health: the range of medical services are often inadequate 1989 (Melbourne: Monash University, 1990) and or lacking altogether. The study has made no Austmlian private medical care, costs and use I975 adjustments for these changes and purports only to and 1986 (Canberra: Australian Institute of Health record the changes in private medical care use, 1990). which may include the net effect of redistribution This study is a pioneering study of the changes of services between the public and private sectors. in private medical care Over those ten years and The study provides what we believe is a valuable provides the information in a structured and com- broad perspective on the changes in private medical prehensive manner not previously available. The care over the period and at the same time raises a study set out to examine changes in the cost and number of questions about the health system that use of private medical services, i.e. those for which warrant further examination. a fee was charged and reimbursed through the universal health insurance system. Roy Hatvey and Maty Nicoll A major difficulty in setting up a comprehensive Austmlian Institute of Health Australian study was establishing two periods for October 1990 Canbenu which comprehensive and comparable national data were available. April to September 1976 is the only VOLUME XIV, NUMBER 4,1990 COMMUNITY HEALTH STUDIES http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

LETTERS TO THE EDITOR

Australian and New Zealand Journal of Public Health , Volume 14 (4) – Dec 1, 1990
Download PDF
2 pages

Loading next page...
 
/lp/wiley/letters-to-the-editor-N6n0sAIKx1

References (0)

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Wiley
Copyright
"Copyright © 1990 Wiley Subscription Services, Inc., A Wiley Company"
ISSN
1326-0200
eISSN
1753-6405
DOI
10.1111/j.1753-6405.1990.tb00051.x
Publisher site
See Article on Publisher Site

Abstract

COMMUNITY HEALTH STUDIES VOLUME W, NUMBER 4, 1990 LE‘lTERS TO THE EDITOR Sir private patients in public hospitals triggered the so- The paper ‘From Medibank to Medicare: trends called ‘Section 17 dispute’ which led some specialist in Australian medical care costs and use from 1976 groups in New South Wales to withdraw their to 1986’ by Moms Barer, Mary Nicoll, Mark services in 1984. As a result, in 1984 the Commonwealth Govern- Diesendorf and Roy Hantey (Community Health ment established the Committee of Inquiry into Sfud 1990; 14: 8-18) contains a serious flaw. The paper reports a statistical analysis of chan- Rights of Private Practice in Public Hospitals, with ges in the volume and costs of private medical care Professor David Penington as chairman. The other in Australia between 1976 and 1986 undertaken by members of the committee were Dr Brendon officers in the Australian Institute of Health. Kearney of Adelaide and me. The committee Reports of the analysis are also appearing other functioned for six months and dealt with many publications. The study purports to show changes in issues. It delivered its Final report in September per capita utilisation, costs and mix of ‘private’ 1984. medical services (i.e. those for which medical One issue related to the assertion that services in radiology and pathology had increased dispropor- benefits were payable) between April - September tionately higher than other services, based on half-years of 1976 (under Medibank) and 1986 (under Medicare). figures from the Commonwealth Department of For much of 1975-76 (and during the six Health showing payments to patients for ‘private’ months the study selected for 1976), Medibank examinations. The committee demonstrated quite arrangements prevented the payment of benefits for conclusively that the assertion bore no relationship diagnostic services to in-patients classified as to the facts and resulted from an error in taking ‘private’ in public hospitals. Hence radiology and 1975 -76 as the base year. pathology services provided to these patients In its Final report the Penington Committee escaped the count of medical services provided to recorded (page Al) that the situation ‘had the ‘private’ patients in this period., Other medical effect of significantly reducing total claims for services were unaffected by the situation. Benefits Medical Benefits for Pathology and Radiology services in that year’. Pages 44-51 and Annexure for these diagnostic services are payable under Medicare. 1 are particularly pertinent to the committee’s Not surprisingly, therefore, increases in pathol- analysis. I quote one sentence (from p. 51): ogy and radiology sewices appear to be dispropor- Growth in utilization (since 1975/76) as shown tionately higher when numbers and costs of private in the Medical Benefits data therefore reflects medical services rendered in later years are com- redistribution of services from the public to the pared with private medical services provided in private sector. 1975 - 76. Although the paper published in Community The authors are either unaware of the Penington Health Studies acknowledges that Medibank did not Inquiry and its report or have chosen to reject its permit public hospitals to charge private patients findings. It is strange, whichever is the case. If they are unaware of the report, their credibility is in for diagnostic services, its calculations make no question. Alternatively, if they reject the report’s allowance for that fact. Thus the study seriously Overstates the rate of increase in the volume, cost data and conclusions on radiology and pathology and mix of ‘private’ radiology and pathology ser- services, they have done so without producing new evidence or refuting the committee’s evidence. In vices provided to the population per capita since fact, the authors would be unique in being the first then. Medibank’s arrangements for the provision of in six years to challenge the data which, though unpalatable, were accepted by Dr Neal Blewett and medical services, particularly diagnostic services, to VOLUME XIV, NUMBER 4,1990 428 COMMUNITY HEALTH STUDIES Dr John Deeble. period, prior to 1984, for which there are data Further, confidential information has been made thatare broadly comparable with post-1984 data. In reporting the study we indicated the difficulties and available to me recently by companies which supply dangers in making comparisons between two similar x-ray fh. It shows that the area of doublesided but not identical universal health insurance systems emulsion fh, as is used for items in Part 8 of the and Over a period when there were significant Medicare Benefits Schedule, sold per head of changes in the health insurance systems. population has declined slowly and progressively One of the differences between the two schemes, from 1983 to 1989. This fact is not compatible with a si@icant increase in Part 8 radiological examin- as Dr Cashman correctly points out, was the e@- ations. bility for reimbursement of fees for diagnostic I am concerned that the flawed interpretation of services provided to private patients in public data in the Australian Institute of Health study will hospitals. In 1976 under Medibank, fees were not charged for such services and therefore were not fuel misunderstanding between the medical profes- counted as private medical services, but in 1986 sion on the one hand and the Government and the Department of Community Services and Health on under Medicare, fees were eligible and included. the other if they take the study at face value and We were aware of the change and undertook some analysis to identlfy the magnitude of the effect. On act on its contents. the basis of available data it was estimated that in 1985-86 about 8 per cent and in 1986-87 about DrLD. Carhman 12.5 per cent of pathology services reimbursed Macquarie Street under Medicare were provided by hospitals. Adjust- August 1990 Sydney ing for this would reduce the level of increase in pathology services. However, it remains substantial. The change in respect of private patient diagnos- tic services was of course only one of a number of Sir changes that took place in the health care system Dr Cashman claims that the study undertaken by during the period examined, including restructuring the Australian Institute of Health concerning the of the pathology schedule in 1977. Some of the changes in use and costs of private medical care in changes may have had the opposite effect and the period 1976 to 1986 contains a serious flaw. shown reduced utilisation levels. If an adjustment The study has been reported in ‘From Medibank were to be made for one change, it would need to to Medicare: trends in Australian medical care costs be made for all changes and across all medical ser- and use from 1976 to 1986’ (Communiry Health vices. As the Penington Committee acknowledged, Stud 1990; 14: 8-18), ‘Changes in private medical the data needed to make such adjustments across service use, 1976 to 1986’ in Economics and health: the range of medical services are often inadequate 1989 (Melbourne: Monash University, 1990) and or lacking altogether. The study has made no Austmlian private medical care, costs and use I975 adjustments for these changes and purports only to and 1986 (Canberra: Australian Institute of Health record the changes in private medical care use, 1990). which may include the net effect of redistribution This study is a pioneering study of the changes of services between the public and private sectors. in private medical care Over those ten years and The study provides what we believe is a valuable provides the information in a structured and com- broad perspective on the changes in private medical prehensive manner not previously available. The care over the period and at the same time raises a study set out to examine changes in the cost and number of questions about the health system that use of private medical services, i.e. those for which warrant further examination. a fee was charged and reimbursed through the universal health insurance system. Roy Hatvey and Maty Nicoll A major difficulty in setting up a comprehensive Austmlian Institute of Health Australian study was establishing two periods for October 1990 Canbenu which comprehensive and comparable national data were available. April to September 1976 is the only VOLUME XIV, NUMBER 4,1990 COMMUNITY HEALTH STUDIES

Journal

Australian and New Zealand Journal of Public Health – Wiley

Published: Dec 1, 1990

There are no references for this article.