Following revelations that HealthEngine does not allow users to opt out of data collection practices that pass on patient information to third parties, the Australian Dental Association (ADA) urges the public to scrutinise the activities of health service provider directory Whitecoat, which has significant private health insurer shareholder ownership.

HealthEngine is an online service that enables users to search for and book appointments with health service providers. Australian Broadcasting Corporation (ABC) reporting shows that HealthEngine has passed on patient data to third parties such as plaintiff law firms. Patients have subsequently been sent direct marketing material based on their personal data.

President of the ADA, Dr Hugo Sachs, said, “While some users of the service may consciously wish to receive such marketing, the ABC reports noted that there is no ability for users to opt out of having their details passed on in this manner, as outlined in HealthEngine’s Collection Statement”.

“The reality of the world of apps and online services is that the array of terms and conditions of use and so on are not easy to read. Understandably, the vast majority of users just accept them, but do not know the full implications of how their personal data is used.

“This is not the fault of the consumer. The ADA believes that the onus should not be on consumers to trawl through such fine print when accessing online services.

“Informed consent is a key principle in healthcare and should extend to online services seeking to link consumers to healthcare providers. Consumers’ health information is particularly sensitive. As a bare minimum, there should be a legislative requirement giving consumers the ability to opt out of sending their health data to third parties for commercial purposes.”

The ADA has also raised concerns about another corporately owned, and commercially run health consumer service – Whitecoat.

Dr Sachs continued, “Whitecoat purports to be an independent means for the public to search for healthcare providers, but the fact that three health funds have significant shared ownership of this service and has representation on its Board raises real questions. The ADA is concerned about conflicts of interest.”

First, when a consumer searches for a local health provider on Whitecoat, search results appear in batches of five or so providers at a time. To see another five, the consumer must click ‘Load more’. Where a provider sits within the order of presented search results depends on whether the provider has ‘opted in’ to Whitecoat, the provider has paid Whitecoat a monthly fee for use of the online booking function, and the number and quality of reviews.

Second, ‘star ratings’ for providers are based on average ratings given in response to survey review questions consumers are asked to complete as part of their review of the provider. (Consumers also have the additional option of leaving a written review).

Whitecoat’s moderation policy gives it the right to edit, remove, or simply not publish reviews, and this puts it in a position to favour dentists contracted to those three health funds.

Dr Sachs said, “Should Whitecoat choose to exercise the rights it accords itself in its moderation policy, for example, by opting not to publish, or include particular survey responses or written reviews about specific providers in its ‘count’ for star ratings or ranking purposes, it may favour particular providers over others.”

The ADA’s concern about the conflicts of interest are inherent in Whitecoat’s financial relationship with health funds and are founded in past experience with nib’s development of the earlier iteration of Whitecoat, prior to the establishment of the joint venture.

It emerged during consultations between nib and a range of health professional associations, that the ranking system and price comparison mechanism nib had planned to use on Whitecoat was skewed to favour a corporate group provider. nib had a contractual relationship with this provider prior to the introduction of its First Choice Provider network.

Dr Sachs pointed out, “Although nib undertook to rectify this bias at the time, this was only because it came under pressure to do so because of external scrutiny. Unless Whitecoat is subject to close monitoring by an independent regulatory authority, as recommended by the ADA, health providers and consumers cannot be confident that its operations are not affected by the conflict of interest posed by its financial relationship with several major health funds.

Whitecoat claims that it wants to help consumers “to make better and more informed choices” with respect to health providers. However, a key reason the National Law prohibits the use of testimonials in advertising is that testimonials “may misrepresent the skills and/or expertise of practitioner”. The ADA is aware of cases where Whitecoat’s reviews displayed very positive reviews and ratings for practitioners whom the Australian Health Practitioner Regulation Agency (AHPRA) had suspended the practitioner’s registration.

Dr Sachs concluded, “Considering recent revelations about HealthEngine’s practices, government regulators must closely monitor the content that appears on Whitecoat.

“The public should think twice before using Whitecoat, and ask themselves whether the information on that website is fair dinkum”.