Private health insurers are moving deeper into Australia’s general practitioner (GP) sector, buying up clinics across the country and reshaping how primary care is delivered, according to Medscape News Australia.
Medscape reported that Medibank now owns or has stakes in more than 160 GP clinics nationwide. Meanwhile, Bupa operates 33 medical centres and plans to expand to 130 within the next three years.
Doctors say this shift could influence how patients move through the system, particularly when it comes to referrals. With insurers involved in both funding and providing care, there are concerns that patients may be steered towards providers within the same network.
“That’s going to reduce patient choice, it reduces patient autonomy, the doctors become hamstrung in terms of doing the best for their patient, they’re going to be restricted as to where and how they can refer. They’re just clipping the ticket at every step of the journey,” said Aniello Iannuzzi, MD, chair of the Australian Doctors Federation.
“Instead of the doctor being entirely focused on the patient, unfortunately, these monsters in the room, the government and the corporates, are having more and more influence over the relationship and on the delivery of care.”
Medscape also highlighted broader concerns about vertical integration, where insurers operate across multiple parts of the healthcare system.
“Unfortunately, we appear to be following the US trends in terms of vertical insurer control of various parts of the health system. We have anxiety about the fact that health insurers are not only the company that pays for the service, they’re also the company that provides the service and influences the price that’s then charged to patients, and potentially to taxpayers,” said Julian Rait, MD, vice president of the Australian Medical Association, adding that this structure could channel patients toward insurer-linked providers.
The trend is emerging alongside wider changes in the healthcare landscape. Medscape reported that private equity firms are also acquiring GP and specialist clinics, contributing to consolidation across the sector and increasing pressure on independently owned practices.
There are also concerns about how this could affect access to care in regional areas.
“Private equity might well over time decide that they want to focus again on areas where there’s higher margins or more activity,” Rait said.
The expansion is taking place as demand continues to strain the public system. Under Australia’s universal healthcare model, doctors set their own fees, with patients able to claim rebates through Medicare. Consultations are free when fees match the rebate under bulk billing, which is most common in general practice. However, longer waiting times have pushed some patients to seek treatment in the private sector.
“We have a safety net provided with universal healthcare through the public system. But what’s been happening, of course, is that because there’s been excess demand on that system, many patients who otherwise would only ever be able to access care through the public system are increasingly turning to the private sector to get necessary elective procedures done,” Rait said.
For now, Medscape reported that calls are growing to monitor how much influence insurers gain across the system.
“It can only lead to patients and taxpayers paying more in the long term as the corporate models get more control of the system. We’re not at the point yet of needing a Break Up Big Medicine Act, but we certainly should be trying to limit it now,” Rait said.
