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Medical Indemnity

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BY ASSOCIATE PROFESSOR JULIAN RAIT

As previously covered in this publication, the profession’s concerns about medical indemnity insurance have re-ignited since the Government announced reviews of all Commonwealth funded medical indemnity schemes and the underpinning legislation.  

At the height of the indemnity crisis in the 2000s, many practitioners faced uncertainty about the future of their practice, with some thinking about leaving the profession all together.

Everyone was vulnerable.

The AMA played a pivotal role in stabilising the industry by bringing the profession together, and working with Government, to design schemes that were more equitable and affordable for practitioners.

However, these protections put in place by then Health Minister Tony Abbott looked to be under attack of late – indeed a saving has already been garnered through the MYEFO in December, along with the announcement of the review.

Since December, we’ve had a new Minister and thankfully, as it appears, a new approach. Following extensive lobbying by the AMA, the Terms of Reference (ToR) for the reviews into the Medical Indemnity Schemes appear to be far more informed.

The review has just commenced and the ToR appear to be more focussed on stability, understanding the importance of affordable indemnity insurance and affordable health care, and considering the international experience.

From an AMA perspective the schemes have been a resounding public policy success. They should remain and be strenuously defended.

We’re also aware that Medical Defence Organisations (MDOs) have been discussing what they wish to achieve through the review – including insuring that the outcome continues to promote stability in the industry, and maintains affordable premiums. 

It is also expected that the role of insurers in providing universal cover – that is the requirement to be an ‘insurer of last resort’ in a particular jurisdiction, will come under review.

From an AMA perspective, there is a strong belief in the importance of universal cover, and that all indemnity insurers should be required to provide it, and that the arrangements should be fair and equitable. The last thing we want to see is a situation where an insurer, rather than a regulator, decides who can effectively practise in the medical profession.

From an insurance perspective, there is a desire to be able to charge a premium that reflects the level of risk in providing coverage, and to have a mechanism to encourage a practitioner to engage with the MDO and improve their practice.

One of the issues related to the indemnity review is any legislation changes that may be considered as part of ongoing AHPRA and MBA work. This potentially includes requiring indemnity insurers to disclose civil claims to AHPRA.

As all members know, the AMA does not support poorly performing practitioners. However, in absence of any level of detail about how these proposals will work we remain highly wary. Furthermore, a civil claims settlement, and poor medical practice, are not necessarily one and the same thing.

However, it is clear that there is an appetite in some jurisdictions for looking at mechanisms to reveal potentially poorly performing doctors – this builds on previous attempts via the revalidation agenda.

It is therefore critical that the AMA continue to advocate on behalf of our members on the importance of indemnity insurance; the critical requirement for the insurer and the regulator to be separate; and to address any ill thought out or underdeveloped approaches that unfairly target practitioners.

To that end, the AMA will closely watch the forthcoming proposed legislative changes, and the revalidation work underway by AHPRA.

In the meantime, Federal Council has reaffirmed our support for universal cover arrangements, and work has begun on our submission to the indemnity reviews.

But in the immediate term, this review needs to hear from the whole profession. The AMA has written to the Colleges, Associations and Societies, and in this publication, encouraging contributions to the Government’s indemnity review.

Providing affordable insurance flows directly through to affordable care, which is an issue the profession is focussed on right now. We need to ensure our voices are heard. For those who wish to make a submission, please see:

http://www.health.gov.au/internet/main/publishing.nsf/content/medical_Indemnity_First_Principles_Review

AMA Members are also welcome to directly contact me via my email address as follows:

jrait@eyesurgery.com.au

 

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