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24 Jan 2018

The AMA continues to be at the forefront of the campaign for better products from the private health insurance sector, repeating its warning that any increase on a product that is not offering value to its consumers has got to be a concern.

Following the Federal Government’s assurance that Australians would get the lowest insurance premium increase in more than a decade, albeit at double the rate of inflation, AMA Vice President Dr Tony Bartone undertook a number of media interviews to stress that the AMA had been asking for better value products, not products that actually increase in cost.

“Consumers and patients alike are making decisions based on information, and then purchasing products and then finding they're not covered for what they thought they were covered for,” Dr Bartone told the ABC.

“Or there are exclusions or restrictions on those policies. We need better value in those products before we can talk about any increase. We need sustainable private health insurance, and if consumers are making decisions to opt out based on further increases on a product that they see of little or no value, well, that's only bad for the health industry as a whole.

“There are so many tens of thousands of policies out there. It's extremely confusing. You’d need a double degree to actually work through all that, and then at the end of the day, you still might not be correct.

“There is a review, there is a roundtable at the moment, but we need all parties to get together and to come out with a process that actually makes it very clear to the consumers what they're getting, that offers them value for money, and offers them an insurance that gives them the cover they need, when they need it.”

The cost of private health insurance is set to be the lowest hike in more than 15 years, with the average increase to be about 3.9 per cent.

The premium changes come into effect on April 1 and will represent a rise that is double the inflation rate.

The average family can expect to pay more than $150 a year extra on hospital cover.

The announcement comes at a time when more Australians are opting out of private health insurance.

“No doubt many are opting out because of a bad experience,” Dr Bartone said.

“They’ve come to use their product that they’ve been paying for for many, many years, and then find, when the crunch comes, they’re not covered or they’re significantly out of pocket.

“This is about ensuring the long-term viability of the private health insurance area to make sure that we’re taking the burden off the public hospital system. A necessary part. The two work hand-in-hand, like hand in glove, and we need a really good functioning private hospital area to take the burden, another option.

“The vast majority of elective surgery happens in private hospitals, and we need people not to opt out but we need them to maintain it. And where people have the ability, they should be facilitated in making that decision to keep that.”

Dr Bartone said it was not a question of criticising the private health insurance sector, but about making it very clear that more needs to be done.

“Everyone's at the table, everyone has their specific little wish list or agenda, but we need to make sure that the Australian public, the Australian patients, are getting value for money,” he said.

“They’re the ones at the end of the day that are left holding the baby… and they need value for money. We don't need them opting out because that's, as I say, bad for everybody.”

The AMA has called for a simplification of the policies into gold, silver, or bronze, so consumers know exactly if they are getting a premium product, a middle of the road, or another product.

“We don’t need products that all they do is deliver a tax deduction and offer you nothing other than just a public hospital treatment,” Dr Bartone said.

“That’s in nobody’s interest. Junk policies do no consumer and no patient any worthwhile benefit, and we need to ensure that there is that clarity. And our gold, silver, bronze allocation with some having no excesses or no exclusions or no restrictions and others having a combination – that’s very clear, is in everybody's interest.

In a subsequent doorstop media conference, Dr Bartone said the announcement of increases in private health insurance was concerning because the increases were not being matched by increasing value.

“Right along we’ve said that private health insurance needs to deliver more value to patients, more value to consumers, to make their products both affordable and attractive,” he said.

“Every day, Australians are making decisions to opt out of private health insurance. These increases will only bring that question even further into light. We need to ensure that Australians keep their private health insurance, because the private health system delivers significant benefits to the entire health system.

“It takes the pressure off the public health system, and any decision of Australians to continue to opt out of private health insurance will only put pressure on an already overburdened public hospital system.”

Dr Bartone said consumers must take particular note of the fine print of private health insurance premiums.

“It’s the exclusion for this particular surgery or that particular surgery,” he said.

“Pregnancy, for example, is not covered in a majority of policies and that in itself is a concern, when a vast number of the many thousands of pregnancies are unplanned, and leaving people having to make decisions then.

“It’s about understanding that across all those things.”


Published: 24 Jan 2018