On April 1st 2015, any health insurance policy containing a modality that is classed as ‘unproven’ is set to have its rebate removed. A leaked draft of the report indicates that all are set to fail the test.
More than 70% of Australians use a natural therapy as part of their health care. Frequently the cost of these appointments attracts benefits from private health funds, most of which have policies that include complementary therapies.
However, this arrangement is under threat. A review of 17 holistic therapies and health-enhancing practices was initiated in July, 2012, by the National Health and Medical Research Council (NHMRC) in collaboration with the Department of Health, and is due to culminate within the next few weeks.
On April 1st 2015, any policy containing a modality that is classed as ‘unproven’ is set to have its rebate removed. A likely outcome is that health fund policies will be pressured to remove natural therapies classed as ‘unproven’ in order to protect rebates on their other coverage areas. This move is certain to be unpopular with users of natural therapies, the majority of whom are probably unaware of these moves.
A full list of those covered under the review is:
- Alexander technique
- Bowen therapy
- Herbalism/Western herbalism
- Massage therapies, including shiatsu
- Tai chi
This review is looking for what it describes as ‘high-quality’ evidence, and will be based on systematic reviews rather than randomised controlled trials, thereby bypassing what is known as ‘Level 1’ evidence, and the time window being examined is a narrow five-year period.
A leaked draft of the report indicates that all are set to fail the test. Alexander technique, massage, tai chi and yoga are considered to have the best evidence to back them up, but as this is considered low to moderate quality, they will still fail to meet the stringent requirements. This conclusion about a shortage of proof is not shared by naturopathic peak bodies, which point to a wealth of clinical evidence.
The leaked draft report stresses that absence of evidence does not mean evidence of absence, but it remains to be seen whether this nuance will be picked up by the media, or whether it will dumb down the message and pander to the prejudices of its audience.
Some taxpayers’ money supports private health funds through a 10-39% government rebate on the cost of policies. Of all the different areas of coverage, payments for natural therapies have been increasing the fastest, with a remarkable 345% increase between 2002-3 and 2012-3.
Despite this fast growth, in 2012-13 these therapies represented just 3.6% of non-hospital treatments, and the overall economic impact on rebates would have been very slight, even if every single natural therapy user had taken out their health fund policy in order to access complementary therapies.
Parallel with this review, the NHMRC has been conducting a separate review of homeopathy [see article p.33]. A draft of its report released in April, 2014, stated that there was no reliable evidence that homeopathicremedies are effective in treating health conditions. When Complementary Medicines Australia (CMA) put in a Freedom of Information request, it found that two of the three experts consulted by the NHMRC expressed numerous concerns about the methodology and selective use of data, but they were overridden.
Despite no final report having yet emerged, the NHMRC’s draft has been used as leverage against homeopathy, with criticism of training institutions, financial support for students, and pharmacies that stock homeopathic medicines. A similar dynamic may soon be at work against a far broader range of naturopathic modalities.
If health fund coverage is lost for most of these therapies, financial disincentives will deter many people from taking them up, practices will lose a chunk of their clients, and some that are less financially viable may have to close.
This move to remove natural therapies from private health is arguably short-sighted. Submissions to the review have pointed out likely downstream effects, including an increase in GP visits, plus upward pressure on both Medicare rebates and Pharmaceutical Benefits Scheme costs. Other consequences may include increased health fund premiums due to greater demand on allopathic medical services.
Early this year, the health fund AHM put a short pop-up animation on its website home page, indicating that a restructure of one of its policies would cut down premiums by removing ‘useless’ therapies, namely ‘flower therapy’ and ‘Swedish cupping’. It would however leave the ‘useful’ ones, which it names as optical, dental, physiotherapy and chiropractic. This message about what sounds like a couple of natural therapies is negatively colouring the public’s attitudes at an important time, and deserves some feedback.
Behind the scenes, active networking within the industry is taking place, led by CMA. As members of the public, we can help by sharing news about these plans on social media, signing petitions, and writing to the Federal Health Minister Sussan Ley.
Department of Health natural therapies private health insurance review http://www.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies
Rebate petition http://chn.ge/1zdvNQF
Massage rebate petition http://chn.ge/1F1Deep
AHM complaints www.ahm.com.au/contact-us
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