7.4 Other issues

Private health insurance

During consultations, the Australian Health Insurance Association (AHIA) expressed concerns about the cost impact of expanded training settings, and the subsequent effects on insurance prices and costs. Increases to insurance prices could have ramifications for uptake of insurance policies by consumers.

The AHIA suggested that greater consideration be given to factors that could influence costs such as:

• increasing payments for the gap between Medicare and private specialist / trainee fees
• the flow-on effect of training costs to insurance premiums
• reduced specialist productivity, resulting in higher costs.

The cultural change required to allow specialist trainees to provide services to private patients was also raised. Privately insured patients expect to be treated by senior specialists of their choice as far as possible. The AHIA occasionally receives negative feedback when privately insured patients are assessed by trainees. Informed financial consent for treatments by specialist trainees would also need to be resolved.

The AHIA concluded that significant work, suitable for training, is still undertaken in the public sector and medical workforce training was not the financial responsibility of their members.

Medical indemnity

Medical Insurance Industry Association of Australia (MIIAA) members are able to provide indemnity insurance for supervisors and specialist trainees in expanded settings, but need clear information about the pre-existing indemnity status of the person undertaking training. This is particularly so in situations where public sector indemnity may extend to the private sector. The MIIAA also sought clarification about who has responsibility for funding the necessary cover.

The MIIAA emphasised that the supervisor and specialist trainee would need to be involved in an accredited training scheme, but said they would not be concerned about the accreditation of a particular site or component of the program.

Specialist trainees who are generating Medicare earnings do not present a problem for indemnity arrangements unless this results in relatively high earnings and greater responsibility affecting the classification of the specialist trainee. For example, an advanced trainee close to the end of training may be working close to the level of a fully qualified specialist and - as insurance premiums are related to private income and the amount of private work - this could affect the level of premium.

These issues are also summarised in the MIIAA submission to the Productivity Commission Health Workforce Inquiry (2005) which gives examples of the relatively low levels of premium that would normally apply to specialist trainees.

It was suggested that establishing or funding specialist training arrangements in the private sector would require further liaison with the relevant medical indemnity insurer to ensure that adequate indemnity coverage was being provided.