Bupa calls for reform to keep health system out of 'intensive care'

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Australians would benefit from an overhaul of private health care to allow insurers to fund more out-of-hospital services, address waste and create empowered consumers, according to a report commissioned by Bupa Health Insurance.

The report from economics consultancy Evaluate - A sustainable private health sector: an economic study – has revealed the current limitations restricting private health insurers from funding services that would make private care more relevant, affordable and simpler for consumers, and help take more pressure off the public system.

Bupa CEO Hisham El-Ansary said Australia’s mixed public-private health system has long been considered one of the best in the world, but COVID-19 has exposed its limitations.

“A combination of our ageing population, increasing chronic and complex disease and advances in clinical care exposed the structural flaws, and the COVID-19 pandemic exacerbated them. The AMA says our public hospitals are in crisis, with wait times for surgery increasing year on year since 2015, while the cost of care keeps going up,” said Mr El-Ansary.

“Private health insurance contributes more than $61 billion to the Australian economy each year and adds to economic wellbeing by helping people remain healthy and productive. It also benefits those without insurance through the reduction of public hospital waiting lists.

“But outdated regulations for private health insurance have not kept pace with modern care delivery or the needs of our population. They make it difficult for consumers to access early interventions and out of hospital treatments that would keep them well or reduce the length and cost of their hospital stay."

Bupa said it will use the report’s findings to advocate for reforms that will make private health care more relevant, affordable and simpler for consumers.

It said this will include reducing red tape so that private health insurance can cover more preventative and out of hospital care that reflects modern care delivery and address the increase in chronic illness.

It will also include incentivising best practice care and focusing on outcomes for patients, removing waste and inefficiencies that drive unnecessary costs for consumers, providing private health insurers with more flexibility in how they discount premiums, so they can more meaningfully respond to customer needs and individual circumstances, and empowering consumers to better navigate, understand and control their own health care through improved reporting, transparency and data sharing.

Mr El-Ansary said the company supports reform centred around empowering consumers to better manage their own health and care.

“By 2057, the number of Australians aged 65 and above will double, putting extreme pressure on health care if the system is not fit for purpose. Addressing these issues now will enable health insurance to become more productive and sustainable for consumers and importantly, help create a healthier Australia,” he said.