Industry news

This page brings you news about what's happening in the Private Health Insurance industry, and updates that may be important to you.

Electing to be a private patient in a public hospital

Over the past 12 months, total benefits paid by Queensland Country Health Fund have increased by 21%. One of the contributors to this is increases in the benefits we pay to public hospitals, as more of our Members elect to be treated as private patients in public hospitals.

The benefits we paid in the past 12 months to some public hospitals have increased by more than 40% and unfortunately this directly contributes to higher premiums for our Members. It’s difficult to see how this choice of being treated as a private patient delivers any better health outcomes compared with public patients in a public hospital.

Also of concern are the lengths some public hospitals will go to with encouraging our Members to be treated as private patients.

We had a Member speak with us recently to advise that her partner had suffered a serious injury that required surgery. Following a couple of days waiting for surgery, the Member was approached by hospital staff indicating that if he chose to claim on his private health insurance, they could operate on him immediately. He was told that if he didn’t sign a patient election form to be treated as a private patient, they couldn’t guarantee when he would make it onto the operating list. This is concerning behaviour and we have referred this incident to the Office of the Health Ombudsman.

We share this example to help Members understand the cost impacts on the private health insurance industry and how they can support a better outcome from an affordability perspective for all Members.

The Federal Government is planning to introduce some reforms that should assist with affordability and transparency and we look forward to how this can further improve the value proposition of health insurance for everyone.

Want to know more about what it means to be a private patient in a public hospital, and if it's worth electing to be one? FIND OUT HERE >

Pausing indexation Medicare Levy Surcharge and Private

Health Insurance Rebate Thresholds – extension

This measure will continue to pause the income thresholds at which people qualify for the Government’s private health insurance premium rebate. This pause will continue from 1 July 2018 until 30 June 2021.

Why is this important?

  • This measure is a continuation of the 2014–15 Budget Measure, implemented from 1 July 2015, which paused Private Health Insurance Income Tiers indexation.
  • People will continue to be able to receive the quality health care they need, as the public and private health systems work together.

Who will benefit?

  • The measure benefits the wider community by slowing the growth of the private health insurance rebate.

How much will this cost?

This measure will save $370.9 million from 2018–19 to 2019–20, commencing 1 July 2018.

Private health insurance and prostheses committees

Reform of private health insurance regulation is under way. This measure will:

  • Establish an expert group – the Private Health Sector Committee (PHSC) – to provide technical and specialist advice on designing and implementing the Government’s private health insurance reforms; and
  • Improve the listing and reimbursement process for prostheses by reconstituting the Prostheses List Advisory Committee (PLAC). The PLAC will be enhanced to include additional expertise as recommended by the Industry Working Group on Private Health Insurance Prostheses Reform (the Prostheses Working Group).

Why is this important?

  • Private health insurance is an important issue to many Australians with more than 55 per cent covered by some form of private health insurance. Many consumers see poor value in their private health insurance. Reform is required to ensure consumers, and the Commonwealth through its $6 billion Private Health Insurance Rebate, get better value.
  • The PHSC will thoroughly examine a range of areas, including ensuring products meet consumer needs, that consumers understand what they are buying, and improving competition and the ability of insurers to manage costs. It will consult further with industry where necessary.
  • The PHSC will be chaired by an eminent person and comprise up to 12 members with expertise in areas such as private hospitals and consumer issues.
  • The PHSC will cost $2.2 million over three years – a minimal investment compared to the potential impact of reform on the $19 billion private health insurance industry.
  • Currently, private health insurers are required to pay benefits for prostheses that are often higher than market prices. This then places pressure on premium rises.
  • The PLAC will be reconstituted to include additional expertise, and will further develop and advise on implementing changes to the prostheses listing process recommended by the prostheses working group. This will improve the listing process, and deliver better value for consumers.

Who will benefit?

  • Reform to private health insurance regulation will mean improved value for money for consumers and they will better understand what they are buying.
  • Insurers will be better able to manage costs.
  • Reform will also support the Commonwealth in getting better value through its $6 billion Private Health Insurance Rebate.

How much will this cost?

This measure will cost $2.2 million and the department will absorb the costs of the PLAC from 2016–17 to 2018–19, commencing 1 July 2016.

This information was released by the Australian Government Department of Health as part of the 2016-2017 Budget.