A row has broken out between health insurance companies and oncologists who have decided to stop prescribing free cancer drugs to private hospital patients, The Sunday Times has learnt.
Patients are billed for a service – it’s not an issue of daily rates
Insurers noted prescriptions were withheld after they refused to continue paying doctors’ “increasingly high professional fees in full”, but oncologists flatly denied this.
Every patient is entitled to free cancer drugs whether administered in a private or state hospital. But if doctors withhold the prescription the chemotherapy has to be bought, jacking up the fees for private treatment.
The Malta Insurance Association – which represents all local insurance companies – said it could not understand why insurers had to foot the bill for drugs, which the Health Department agreed could also be provided at no cost in the private sector to free up hospital beds at Boffa Hospital.
However, oncologist Stephen Brincat, who heads Mater Dei Hospital’s Oncology Department, believes there should be a distinction between private and public patients, adding that insurers should not attempt to run a private health service off the government's back.
The dispute started on May 1 when Prof. Brincat and two other oncologists terminated the years-long practice and stopped writing prescriptions for free drugs to those receiving cancer treatment at Saint James Hospital.
But the matter has only just come to the fore and Saint James Hospital Group chairman Josie Muscat is hoping a solution is found fast as the hospital is caught in the middle.
“We’re obviously upset at the situation. Not everyone can afford to buy cancer drugs and if there’s no direct settlement from insurers we are going to lose patients.
The quicker it’s resolved, the better,” he said.
When contacted, the insurers’ association said various members had earlier this year been jointly approached by the only three oncologists working in private practice to “meet about certain shortfalls in insurers’ reimbursements of their fees”.
The association explained that insurers could not discuss reimbursements with all three as this would be in violation of competition law and could potentially result in price fixing.
The association said it was becoming increasingly concerned that the daily rates being charged by oncologists varied between €300 and €450 a day. A course of treatment could last up to three days or more.
Insurers said that in comparison, an entire course of treatment in the UK could cost what was being charged locally per day.
“Oncologists started to intimate that they were under no obligation to authorise the transfer of chemotherapy drugs from government pharmacies to private hospitals,” it said.
“Eventually, when association members refused to continue to refund their increasingly high professional fees in full, they withheld prescriptions for patients to use oncology drugs in private hospitals from May 1.
“Insurance companies will pay up to what they consider to be fair and reasonable charges. Thankfully, in most areas, fees are paid in full but, unfortunately, in the area of oncology the fees charged in the private sector have been considered by most insurers to be excessive,” the association added.
Prof. Brincat said this was “absolutely untrue”, adding there was “very clear correspondence” showing their decision was not linked to higher fees.
He also refuted claims that oncologists’ fees were higher than those in the UK, and highlighted the personalised service Maltese doctors provided even after the treatment from replying to e-mails, SMSs, and mobile phone calls.
“Patients are billed for a service – it’s not an issue of daily rates. The problem is insurance companies don’t have people professional enough to assess fees. Instead they appoint a GP who has no idea of the work involved, or the complexity of the treatment,” he said.
Oncologists’ fees have remained unchanged for at least five years, he said, insisting that none of them had asked for these to be revised.
Prof. Brincat also denied oncologists were protecting their interests. On the contrary, if they were seeking to line their pockets they would be promoting private practice not encouraging patients to go to Boffa Hospital.
So what was it that sparked their sudden decision to stop issuing prescriptions?
“The increasing hassle with administration sparked it. It takes a lot of trouble to actually manage to get drugs transferred from one place to another, even within the public health service,” Prof. Brincat said.
“The amount of administration involved in getting drugs to the patient is unbelievable; the amount of paperwork that has to be done, redone, signed, counter-signed... it never ends. All we want to do is make our position the same as that of other consultants.”
If patients were encountering problems because of their decision, they were entirely free to go to Boffa, he said, where they would receive the same treatment as they would privately, under the same consultant, and at no cost.
Prof. Brincat said it was unheard of in the UK, or in any other country, for private health insurance companies to expect the government to provide the drugs for free.
“You cannot have a private system and then give the bill to government, or the patient. It is the responsibility of the insurance companies to supply the drugs, one way or another,” he said.
If insurance companies did not like their position, Prof. Brincat said, all they had to do was make a direct arrangement with the government and leave oncologists out of it.
Asked if the oncologists’ decision was eradicating cancer patients’ right to choose to be treated privately, Prof. Brincat said the insurance companies were the ones restricting this choice. However, the insurers’ association pointed out that it had long been accepted practice, with the health authorities’ blessing, for cancer drugs to be provided free in the private sector.
The Health Department confirmed this practice and said it had not altered any policy and not given any instructions to halt this “concessionary arrangement” aimed at “reducing the hardship for cancer patients”.
This measure allowed cancer patients entitled to chemotherapy to have this treatment administered in a bed in a private hospital instead of the state hospital.
The arrangement is aimed at reducing the hardship for cancer patients
A request would have to be made to the Superintendent of Public Health by Saint James Hospital’s pharmacy and endorsed by the consultant oncologist.
The health authorities are unable to intervene to resolve this row as they cannot order doctors to issue a prescription.
“The Health Department does not have the legal jurisdiction to oblige a consultant oncologist to apply for government-sponsored treatment for patients being treated outside the public health system.”
In the meantime, Prof. Brincat said oncologists had no intention of reversing their decision as insurance companies had to recognise their responsibilities.