By discouraging members from choosing their own provider, many health funds are doing them a big disservice, argues Dr Rick Olive who heads up the Australian Dental Association (ADA).

Many private health insurers promote the advantages of using a “preferred provider”, but as well as limiting choice for members, this practise potentially impacts their quality of care, says Dr Olive.

Preferred provider networks were one area of criticism in the ADA’s submission to the Australian Competitor and Consumer Commission earlier this year.  The ADA’s position is that the higher rebates offered by some Private Health Funds through their preferred provider networks are diverting patients away from the care provided by their customary treating dentist.  “In the delivery of dental care, continuity of care is paramount as it enhances the prospects of long term oral health” says Dr Olive.

For some patients, choosing a practitioner that is not part of their health fund’s network means getting a lower rebate back from their health fund and in some cases, no rebate at all. 

“The effect is that consumers who choose to maintain their continuity of care pay an artificially inflated price for making that choice” argues Dr Olive.

Who benefits from preferred provider contracts?

“The health fund benefits, not the patient,” says Dr Olive. “Patients should be able to choose their own dentist, doctor or allied health professional and receive the rebates that have been promised to them.”

Dr Olive argues that if members pay the same premiums they should be entitled to the same rebate regardless of who treats them; “There ought to be no impediment to policy holders choosing their provider of choice.  Whether the choice is framed by cost, quality, safety or convenience, that choice remains the prerogative of the policy holder.”

Doctors’ Health Fund believes that limiting practitioner choice is not in the best interests of patients, which is why we don’t have preferred provider networks on our Extras covers.

We believe in freedom of choice

The independence of the patient-practitioner relationship is fundamental to Doctors’ Health Fund. Our members are free to choose any dentist and receive the same benefit.   This approach also supports continuity of patient care, which can achieve better health outcomes for patients.

As Dr Olive explains, this is how it should be. “Special contractual relationships between a health fund and a dentist should be viewed with caution” he says.  “Maintaining patient choice is a crucial element to providing high standards of medical or dental care. Health fund members should not settle for anything less.”

Read more about the ADA’s position on provider choice.