Pain groups note passing of PHI Reform Legislation with some concern

Pain groups have noted the passing of the Private Health Insurance reform legislation through Parliament in September but issued a caution about potential unintended consequences of placing chronic pain in the highest category of cover. 

Changes to the clinical category intended as part of the reforms could disproportionally impact patients with chronic pain and may have far reaching implications for millions of privately insured consumers who rely on existing coverage to access chronic pain management.

Painaustralia and its founding members the Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine (FPM) and the Australian Pain Society (APS) urged the Federal Government to reflect our concerns in the rules currently being drafted that will give effect to the reforms in the legislation. 

Painaustralia CEO Carol Bennett said, “While we welcome the broad intention of the reforms to simplify private health insurance and make it more accessible, it’s important that it doesn’t negatively impact on people living with chronic pain who are some of the most vulnerable in our community and often unable to work.  We don’t want a situation where many are forced to drop their PHI cover altogether, further exacerbating access issues across the public health system.”

Changes to clinical categories and the move to tiers of Basic, Bronze, Silver and Gold significantly restrict access to chronic pain management if (as per the Departments consultation paper) chronic pain is placed in the highest category.

These concerns were also noted by Senator Helen Polley and Senator Richard Di Natale during the second reading of the Bill, with both noting the changes to clinical categories could adversely impact millions of consumers.

Acting Dean of the Faculty of Pain Medicine, Dr Mick Vagg said “It’s vital that the implementation of the reform does not adversely affect access to chronic pain management for those who rely on the private health system to provide appropriate care for their condition. The current form of the legislation raises some concerns that it does not prevent health funds in the future from restricting access to hospital care for the 6.5 million of the 11 million privately insured Australians who don’t have top private health insurance cover.”

Chronic pain is the most common reason that people seek medical help and one in five Australians live with chronic pain.  Pain is also common to many chronic conditions and its impact spans the health, disability and ageing systems.

President-Elect of the Australian Pain Society, Anne Burke said “Consumers already face unacceptably long waiting times to access allied health and multidisciplinary pain services in public hospitals—frequently more than a year and sometimes more than four years — and a large number rely on the private health system to access appropriate care to manage their condition, prevent complications, and retain their quality of life.”

Painaustralia CEO Carol Bennett said, “Minster Hunt has shown leadership in addressing chronic pain as a national health priority and funding a National Action Plan.  We now call on him to ensure people with chronic pain are not unduly disadvantaged by this legislation”.