Doctor of Philosophy
School of Social Sciences, Media and Communication
Flynn, Kathryn, Medical fraud and inappropriate practice in Medibank and Medicare, Australia 1975-1995, Doctor of Philosophy thesis, School of Social Sciences, Media and Communication, University of Wollongong, 2004. http://ro.uow.edu.au/theses/2071
The Australian system of universal health insurance has enjoyed great electoral popularity but the system has been open to abuse and has been beset by administrative inertia, a reluctance by governments to establish reliable estimates of the extent of fraud and overservicing, lack of adequate legislative policy and a very low rate of prosecutions.
The aim of this research is to provide an historical and sociological account of institutional responses to medical fraud and overservicing and the media’s engagement with this issue over twenty years from 1975 to 1995.
Archival sources and interviews with key politicians, public servants and whistleblowers are used to tell the story of how universal health insurance was accepted as a necessary part of the social fabric from the introduction of the Pensioners Medical Scheme in 1951, Medibank in 1975 and Medicare in 1984 but measures to deal with the financial abuse of these systems did not have the same priority. The pathology industry provided the greatest scope for illicit profits through offers of kickbacks and inducements from pathology companies to referring general practitioners and this practice fuelled the growth of entrepreneurial medicine. Whistleblowers in the late 1970s and early 1980s campaigned for legislative and administrative change, but the reform agenda was more successful when it was led by a managing director of the Health Insurance Commission committed to change. These events are contextualised by several theoretical perspectives, including Foucault’s theory of governmentality, the sociology of insurance and of whistleblowing.
The challenges for the 21st century are to maintain the level of resources needed to provide the intensive policing required for the regulation of the financial abuse of medical benefits particularly in the area of electronic fraud and sophisticated criminal fraud.