Meeting 1 Summary Improved Models of Care Working Group of the Private Health Ministerial Advisory Committee 20 March 2018, Department of Health offices (Scarborough House), Canberra

Page last updated: 16 April 2018

PDF version: Summary of the first meeting of the Improved Models of Care Working Group (PDF 137 KB)


Members Members – via teleconference
Dr Jeffrey Harmer AO, Chair Janne McMahon OAM, Private Mental Health Consumer Carer Network
Jo Root, Consumers Health Forum Christine Gee, Australian Private Hospitals Association
Belinda Highmore, Mental Health Australia Marcus Dripps, Allied Health Professions Australia
Andrew Sando, Australian Health Service Alliance Secretariat
Dr Andrew Wilson, Medibank Julianne Quaine, Secretariat
Kelly Johnstone, Bupa Susan Azmi, Secretariat
Professor John Horvath AO, Ramsay Health Care Mitch Docking, Secretariat
Peter Bailey, Wyndham Clinic Private Hospital Anne Dwyer, Secretariat
Associate Professor Graham Mercer, Australian Medical Association Alison Harriden, Secretariat
Professor Ian Hickie AM, Brain and Mind Centre, University of Sydney Other Attendees
Dr Stephen de Graaff, Australasian Faculty of Rehabilitation Medicine Andrew Simpson, Department of Health (Item 8)

1. Welcome and Introductions

  • The Chair opened the meeting and provided members an opportunity to introduce themselves to the Working Group.

2. Opening Statement/Operation of the Working Group

  • The Chair delivered his opening statement, advising members that the purpose of the Working Group is to provide advice to the Private Health Ministerial Advisory Committee (PHMAC) on options to improve the regulation of private health insurance funded mental health and rehabilitation services. The Chair will be responsible for authoring the advice that is provided to PHMAC.
  • The Chair advised that a key consideration for this work is to identify regulatory changes to private health insurance that support access to clinically effective and efficient care that best meets patients’ needs.
  • The Chair discussed the operation of the Working Group, and asked members to be respectful and to share their views in a productive way.
  • The Chair reminded members that they have all signed confidentiality agreements. He noted that members may be required to discuss particular issues with their organisation, but asked that members be mindful of the balance between appropriate consultation and respecting confidentiality. The Chair asked members not to attribute statements or positions to other Working Group members when undertaking consultations.
  • The Chair advised members that the Working Group is advisory only; it is not a decision-making body.

3. Declarations of Conflicts of Interest

  • The Chair noted that he had considered members’ declarations of their interests and did not consider there were any declared conflicts that would prevent participation in the Working Group.
  • The Chair reiterated members’ obligations to advise of new conflicts should they arise during the existence of the Working Group.
  • Members did not declare any new conflicts.

4. Improved Models of Care – Issues Paper and Presentation

  • The Secretariat provided a presentation which gave an overview of issues to be considered by the Improved Models of Care Working Group.
  • The presentation covered current government regulation, including relevant parts of the Private Health Insurance Act (the Act) and Rules. The Act requires all private health insurance products to cover psychiatric care (mental health), rehabilitation, and palliative care, and funding is typically limited to hospital-based care.
  • The current regulation supports hospital-based care, which presents a barrier for consumers and clinicians seeking non-admitted and community-based care. However, evidence suggests that for certain treatments and patient cohorts it may be clinically appropriate and more cost-efficient to deliver mental health and rehabilitation services in non-admitted or community based settings.
  • Members were also provided information on the common types of mental health and rehabilitation services funded by private health insurance. Data show that a majority of private hospital-based mental health and rehabilitation services are delivered on a same day basis, and growth for these services is much higher than average growth across the sector. This growth contributes to the increasing cost of private health insurance premiums.
  • The Secretariat acknowledged the substantial workforce and capital stock related to the delivery of these services in the private sector. Regulatory changes may require considerable industry transition to respond to better supporting more cost-efficient settings of care funded by private health insurance.

5. Member perspectives

  • Members provided a brief summary of their views on models of care and current regulation, which raised a range of issues including:
    • regulation was identified as a barrier to private health insurers funding non-admitted and community-based care;
    • the importance of maintaining independent clinical decision-making in determining clinical pathways and appropriate care settings;
    • care should be patient centred and patients should not be restricted in their choice to access care in other clinically appropriate settings;
    • there is a risk that changes could shift costs onto patients;
    • the delivery of some hospital-based mental health and rehabilitation services reflect an “old” model of care, however the growth in these services is a response to unmet and growing demand; and
    • allowing insurers to fund more cost efficient settings of care would improve value for consumers and may contribute to supporting overall system sustainability.

6. Work plan

  • The work plan was agreed in-principle by the Working Group. The Chair noted that the work plan is indicative and may be refined throughout the existence of the Working Group.
7. Mental health and rehabilitation sub-groups

  • The Terms of Reference for the mental health and rehabilitation sub-groups were endorsed by the Working Group.
  • The Chair advised that Working Group members may participate on the sub-groups or provide nominations to the Secretariat.
  • The sub-groups are expected to be established by late-April.
8. Presentation on Medicare Benefits Schedule Review

  • Andrew Simpson, Assistant Secretary in the Medical Benefits Division of the Department of Health, delivered a presentation to the Working Group on the Medicare Benefits Schedule (MBS) review.
  • The presentation outlined the role of the MBS taskforce in managing the MBS review, the scope of the review, and key learnings relevant to the work of this group.
9. Other business

  • The Working Group noted its next meeting is scheduled for 5 June 2018.

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