Second opinion on A.C.C.

Press, 22 June 1989, Page 14

Second opinion on A.C.C.

A second opinion is a time-honoured and customarily valued tradition in medicine. Allowing the Accident Compensation Corporation to have its own medical experts produce a second opinion in cases in which a patient’s progress seems unsatisfactory is perfectly reasonable. The New Zealand Medical Association does not see it that way. This might be because the corporation’s proposal is an attempt to curb potential patient fraud and, by extension, check any members of the Medical Association who might abet the fraud by too readily certifying patients as unfit for work. The corporation has been at pains to explain that it does not believe doctors are doing this purposefully, or that abuse is widespread, but the association has bridled at what it considers a slur.

Like the corporation, the individuals and industries who shoulder the burden of A.C.C. payouts are only too well aware of the rapid escalation in the cost of the scheme — up $5O million in earnings-related compensation since 1987 — and know what this has meant in higher levies. With these people the ruffled feathers of a few doctors will not weigh heavy in the balance against the knowledge that more is being done to rid the system of abuse wherever potential for it exists. The corporation is checking to see if it has the power to require second opinions on longterm compensation recipients and, if it has, intends to introduce the policy within three months. If a separate legislative authority is required, the corporation - will seek its inclusion in a revision of its empowering act due this year. The Prime Minister, Mr Lange, has lent his support to the corporation. Lacking a system of checks such as the second-opinion policy will provide, the extent of patient fraud can only be guessed at. It

may not be great; but the corporation would be irresponsible if it failed to avail itself of simple and practical measures to reduce the risk. Even if the new policy, once introduced, did not disclose much malingering by patients on earnings-related compensation, the ability to check on long-term recipients of compensation would be no less valuable. Just knowing that the certification of patients unfit for work could .be subject to a second opinion might be enough to encourage busy doctors to take a little extra time to ensure that they do not skimp on A.C.C. consultations and that they are not being misled by lead-swinging patients.

The other side of the argument about reducing A.C.C. costs is that more could be done to rehabilitate patients and get them back to work earlier. The Medical Association has a point when it suggests that the removal of chiropractors and osteopaths, among others, from treatments covered by the scheme has probably lessened the chances of some patients having a speedy return to work. The corporation acknowledges this and wants chiropractic and osteopathy back under the umbrella of A.C.C. The move could be another way to help reduce the corporation’s bill for long-term compensation.

Combating fraud and a greater commitment to rehabilitation are separate and quite different ways of reducing the cost of A.C.C., however. One is not the substitute for the other and both should be pursued. The savings on fraud brought about by having a second-opinion policy might help considerably to offset the extra costs of reinstating osteopathy and chiropractic on the list of A.C.C. subsidised payments.