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Medicare: coming to a post office near you?

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Details of patient consultation items and Medicare rebate claims could end up in the hands of private corporations under Federal Government plans to outsource Medicare and Pharmaceutical Benefits Scheme claims and payment processes.

The Health Department has called for expressions of interest from the private sector to take over the management and processing of Medicare and PBS claims from the Department of Human Services.

Health Minister Peter Dutton said it made good sense to explore the possibility the private sector could provide the service more cheaply and efficiently.

“The current IT systems that manage the claims and payments processes are dated and in need of a substantial upgrade,” Mr Dutton said. “In these circumstances, it is good process to review and test existing and alternative systems.”

Medicare offices are not included in the plan, and would be expected to continue to provide face-to-face services for clients.

But Mr Dutton said private companies already provided data services to the Government, and the “commercial sector may be able to provide a better service to Australians at a lower cost to the taxpayer”.

Australia Post is considered by some to be one of the frontrunners in providing the outsourced service, which involves a massive undertaking.

The successful bidder would have to be capable of processing around 630 million transactions a year, involving claims worth around $31.5 billion.

The idea to outsource the processing of Medicare and PBS claims was presented by Australia Post to the Commission of Audit, and Chief Executive Ahmed Fahour told The Australian Financial Review his organisation was “uniquely positioned” to provide the service.

Already, Australia Post has struck a deal with DHS to provide a digital postal services for agencies including Medicare and Centrelink.

Adding to suspicions that Australia Post is a frontrunner for the possible contract, the window for submitting expressions of interest was very narrow given the potential size of task. The notification was made public on 8 August, and bidders were given just two weeks to lodge their proposals.

The prospect that private organisations will process Medicare and PBS data has some to raise privacy concerns.

Shadow Health Minister Catherine King said she was “extremely concerned” about the implications of the plan for data security and jobs.

“People receiving healthcare and targeted government support… shouldn’t have to stand in line at Australia Post, at some private company’s shopfront or spend hours on hold to some international call-centre, just to lodge a claim or hand in a form,” Ms King said. “They also shouldn’t have to worry about their most sensitive medical and financial details being handed over to a private company.”

The Consumers Health Forum said any move to outsource the processing of Medicare and PBS claims must involve rigorous safeguards to protect patient privacy and interests.

Adrian Rollins

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