AMA: More work required on private health insurance

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The AMA has issued its Private Health Insurance Report Card 2019, arguing all stakeholders must work together to make private health insurance more attractive for more Australians, especially younger people.

AMA President, Dr Tony Bartone, said, “With more than sixty percent of elective surgery in Australia occurring in the private sector, the prospect of greater stress and demand being placed on the already overstretched public hospital system is looming large unless the drift away from private health insurance is stopped.

“Australians need and demand private health policies that are affordable, transparent, good value, and appropriate for their individual or family circumstances, or they will walk away from private health insurance altogether.

“The private health insurers must work closely with the Government to ensure that the hard-won reforms of 2018 deliver on the promise of better cover, more transparency, and greater value – or more and more people will drop their cover or not sign up at all.

“An increasing number of younger and healthy Australians are opting out of private health insurance.

“This is leaving a higher proportion of older patients who are increasingly more likely to be suffering from illness or chronic disease and, as a result, they are more expensive to insure, further driving up premiums. This trend is not sustainable.

“We are still seeing increases in premiums averaging 3 to 5 per cent a year, when wages growth is firmly stuck at around 2 per cent.

“Sooner or later, the number of people with private health insurance will fall further – and dramatically.”

Dr Bartone said the report card provides patients and consumers with clear, simple information about how health insurance really works.

“Navigating the health system is difficult for most people, but even harder when you are sick or disadvantaged,” said Dr Bartone.

“As medical practitioners, we know how important it is to ensure that our patients understand as much as possible about their treatment options.

“The AMA supports patients to understand the fees, costs, and payment options associated with their care. Good health financial literacy is paramount. All patients need clear and concise information and guides.

“The AMA worked with the whole medical profession to produce an informed financial consent guide earlier this year, and that is why we continue to produce this Report Card every year.”

Dr Bartone said the proposed government website to allow people to search specialists’ fees is "meaningless" unless it also lists what patients can expect back from Medicare and their private health insurance fund.

“The AMA supports and actively encourages full transparency of doctors’ fees, and unreservedly condemns egregious billing, which occurs in a very small percentage of cases,” said Dr Bartone.

“But that transparency must extend to both the size of the MBS rebate and the private health insurance contribution to the cost of treatment.”

Dr Bartone said the AMA welcomed the introduction of the Gold, Silver, Bronze, and Basic categories for policies and the standard clinical definitions applied under each category.

“We now have more meaningful and consistent levels of cover in each category,” Dr Bartone said.

“The reforms have also provided better coverage for mental health services and for people in rural and regional Australia, and they have improved the transparency of the private health insurance sector."