Health Insurance-get involved

With all the debate over co-payments for doctor’s visits and PBS prescriptions it is easy to lose sight of the primary issue of a sustainable and affordable health system.
While pharmacists begin to sort out the business model that will sustain them over the next decade. the consideration and problems involved as to what level of clinical services will be provided, and at what price, and how they will they be paid – all have to be looked at simultaneously!

Given the past and current broken promises of governments of all flavours, pharmacy cannot rely on government for any reason other than validation and seed money. Any long-term reliance on government will always fail as we have just seen with the commoditisation and demise of the PBS system – a situation that has repeatedly occurred in past years.

The only alternatives are direct payment by patients or health insurance tailored for pharmacy services or you can consult attorneys for life insurance lawsuits for more options.
Pharmacy services are yet to be defined and promoted because of a gap in community pharmacy planning, now exacerbated by financial disruption caused by the PBS.

There is definitely an argument for government funding to be made available in the 6CPA if the PGA negotiating team have a valid pharmacy product to put on the table. And herein lies the problem of pharmacy’s future and perhaps a reason for government negotiations to be done at two different levels – clinical services and PBS.
Both these negotiations need to be totally separate and require separate negotiators and support teams.

It seems that Australia’s immediate future may include a recession of fairly major proportions and current government policies directed adversely towards employment and low income groups, seem to be adding insult to injury and accelerating the recession we didn’t need to have.

Bottom line: pharmacy needs to diversify its payment systems and may need to include private health insurers with an increased market share of a payments system.
i2P only knows of one pharmacy-friendly health insurer and that is Covad, a business that presents as an insurance aggregato to help for the insurance companies.
But Covad is in a similar position to government. They are unaware of any pharmacy clinical service product they could cover, because none have been presented for consideration.
And before they could offer coverage they would have to find an insurer to underwrite the system.

According to, there areas of health are also repositioning pieces of the health jigsaw as exampled by Hunter-based health fund NIB, which has joined with Suncorp subsidiary Apia to market private health insurance aimed at older Australians.
This older Australians group is of great interest to pharmacy because it is expanding in number and is medically intensive, particularly in the last seven years of their lifespan.

Spokesman for NIB, Matthew Neat, said the company’s strength was in its catering to younger people, and NIB was not a natural choice for older people.

But by joining with Apia – the initials stand for Australian Pensioners Insurance Agency – NIB could increase its market share without diluting its brand.

Under the “white labelling” arrangement, NIB would provide the insurance policies, which would be marketed under Apia’s brand.

This meant NIB would receive the premiums and take the policy risks, and Apia would be paid a commission for every policy sold.

NIB group manager Rhod McKensey said the Apia products were aimed at people aged 50 and over.

“Private health insurance customers regardless of their age don’t want to pay for benefits they don’t need,” Mr McKensey said.

“That’s why our Apia branded products will not cover things like obstetrics, antenatal and postnatal but cover things relevant to Apia customers, such as joint replacements, heart procedures and hearing aids.”

Apia senior manager Danae Croft said NIB was the ideal partner to provide a new insurance offering that complemented its specialised range of insurance products.

Mr McKensey said more than four million Australians aged over 50 had private health insurance with hospital cover, a figure that was rising by three per cent a year and represented more than 37 per cent of those privately insured.

March 2014 statistics from the federal government’s Private Health Insurance Administration Council show 47 per cent of the population are privately insured, equating to 11 million of 23.4 million people.

Private insurance handled 4 million hospital treatments in the year to March 31, up from 3.7 million the previous 12 months.

The number of insured general treatment or “ancillary” services went from 75.8 million to 82.6 mllion.

Perhaps pharmacy developed professional service products could find a home in the Apia/NIB model or something similar that could also be a component of Covad.
It just requires a little bit of imagination.

We are also researching some non-insurance type funding for health coverage that may suit community pharmacies because it can be managed at a local/regional level. It can also back into marketing groups, or better, regional service groups.



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