Joint Statement - Industry and Consumer Panel To Advise Government on Broader Health Cover (BHC) Products

The panel will comprise representatives of the Australian Medical Association (AMA), the Australian Private Hospitals Association (APHA), Catholic Health Australia (CHA), and the Consumers' Health Forum of Australia (CHF).

Under the Government's Private Health Insurance Act 2007, private health insurers can now offer products under the BHC banner that will attract Medicare and private health insurance rebates for services or treatments provided out of hospital.

The definition of hospital treatment under the new legislation has been revised to allow services not provided on a hospital site to be considered as hospital treatment.

This treatment must be provided by, or under the management of, a person authorised by a hospital to provide the treatment.

General treatment (synonymous with BHC) is defined as that which is intended to manage a disease, injury, or condition that is not hospital treatment.

BHC products can substitute for, or prevent, hospital care. Examples are dialysis, chemotherapy, and domestic nursing assistance.

The BHC Panel will work to ensure each proposed new product has clinical efficacy, is appropriate for its designated purpose, meets quality and safety standards, provides consumers with choice, and preserves clinical independence.

Independent expert advice on the safety and effectiveness of new products will then be offered to the Health Minister and health insurers before the products are launched onto the market.

The Panel will meet up to three times a year, and the Department of Health and Ageing and the Private Health Insurance Ombudsman (PHIO) will be invited to participate from time to time in advisory roles.

The terms of reference for the BHC Panel are:

• To analyse the products from the perspective of the consumers and providers with particular focus on (but not limited to) clinical efficacy, appropriateness, quality and safety, maintenance of consumer choice, and clinical independence.
• To consider the cost impact and cost effectiveness of proposed new products with particular focus on monitoring any cost burden for consumers in terms of personal health costs or increased premiums or costs to the health system.
• To co-opt members as required, as nominated by the constituent groups, to offer specific expertise.

As part of its work, the Panel may also seek advice from the PHIO on new products, particularly BHC products, proposed for introduction into the market.

The Panel members consider the BHC initiative a positive and innovative move for the private health sector, which has the potential to provide significant benefits to patients.