New pointer to managed health care MBF's announcement that it will limit payment to members requiring lymphoedema treatment flags the health funds' future intentions clearly. While vigorously denying plans to introduce managed care, they will increasingly decide which treatments receive adequate rebates, thereby restricting choices available to their members. This is not unexpected as the funds have already been discriminating against members choosing treatment from doctors who refuse to become subcontractors in the funds' gap cover schemes. A member who has paid the same premium as all other members and chooses to be treated by such a doctor will be penalised by a significantly lower rebate, even though that doctor performs the same procedure as a subcontracting doctor and even if he or she bills the patient less than the fund's gap cover rebate fee. A gap is automatically forced on the patient, not by the level of the doctor's fee, but because of the way the doctor has chosen to bill the patient.
Funds have the right to determine the premiums they charge, and what benefits they can afford.
They have no business constructing financial disincentives which discourage treatment with doctors just because they maintain their independence of the managed care model. Dr Andrew Pesce, Westmead. We cannot expect GPs to be au fait with the huge range of specialists and sub-specialists available in, say, metropolitan Sydney for conditions they infrequently see. In cancer, which accounts for nearly 30 per cent of deaths, finding the best specialist doctor for you is rather important. You want someone who does relevant procedure regularly, is right up to date and is preferably attached to a multidisciplinary cancer unit.