| 3.1: A sustainable and thriving private health system that provides patients with choice of hospital, medical practitioner, and their treatment plan. |
- Recalibration of the private health insurance policy levers, including Lifetime Health Cover (LHC) loading, Medicare Levy Surcharge (MLS), and the private health insurance premium rebate to better reflect consumer behaviour and changing demographics and better support the objectives of the healthcare system.
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- Increase in uptake and retention rates of private health insurance.
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- Reforms to default benefits and risk equalisation promote the sustainability of the private health system.
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- Improvements in the sustainability of private health system.
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- Regular review of the private health insurance policy levers, supported by ongoing data and evidence collection.
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- Private health insurance policy levers remain contemporary.
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- Greater incentives to support uptake and retention of the appropriate levels of private health insurance.
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- Increase in uptake and retention rates of private health insurance.
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- Address private hospital sustainability issues to ensure patients with private health insurance can continue to use their insurance to access private hospital care.
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- Improvements in the sustainability of private hospitals.
- Continued patient access to private hospitals.
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| 3.2: A private health system that is attractive to patients, transparent, accessible, and delivers value. |
- Mechanisms to increase the value proposition of private health insurance, including a mandated average minimum return amount (e.g. 90 per cent) to the health consumer for every premium dollar paid.
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- Increase in uptake and retention rates of private health insurance.
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- Mechanisms to increase the value proposition of private health insurance in rural areas.
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- Increase in uptake and retention rates of private health insurance in rural areas.
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- Policy settings that support consumers to maximise the value of their private health insurance.
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- Improvements in consumer awareness and understanding of their private health insurance benefits.
- Increase in patients using their private health insurance.
- Reduction of complaints associated with private health insurance.
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- Improved product design transparency to ensure consumers have the appropriate cover.
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- Improvements in consumer awareness and understanding of private health insurance products.
- Reduction of complaints associated with private health insurance.
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- A higher standard of transparency so patients can determine out-of-pocket costs.
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- Broad adoption of informed financial consent processes.
- Improvements in consumer understanding of out-of-pocket costs.
- Reduction of complaints associated with private health insurance.
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| 3.3: A private health system that is attractive for medical practitioners to work in. |
- Establishment of an independent and well-resourced Private Health System Authority to oversee contracting arrangements between insurers, hospitals, and medical practitioners, as outlined in the AMA discussion paper A whole of system approach to reforming private healthcare.
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- Implementation of a Private Health System Authority.
- Reduction in contract negotiation issues.
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- Policy settings and legislation that ensures medical practitioners — not insurers — have the clinical autonomy and independence to decide the type of clinical care with their patients, and where and when they receive it.
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- Implementation of policy and legislation.
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- Financial incentives to improve information technology infrastructure to support digital capability and interoperability.
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- Introduction of financial incentives.
- Improvement in information technology infrastructure.
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| 3.4: Australia’s private health system leads in the development of innovative models of care and comprehensive reforms that are underpinned by patient choice, and clinical autonomy. |
- Establishment of an independent and well-resourced Private Health System Authority to oversee the private health system and create a platform for system-wide reforms, as outlined in the AMA discussion paper A whole of system approach to reforming private healthcare
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- Implementation of a Private Health System Authority.
- Regular sector discussions regarding reform.
- Early identification of potential system issues.
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- Deliberate design of new and innovative models of care that are underpinned by the principles of patient choice, equitable access, safety and quality, and clinical autonomy, as outlined in the AMA research report Out-of-hospital models of care in the private health system.
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- Implementation of new models of care.
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- Stronger regulations to prevent selective and restrictive contracting and vertical control which threaten patient choice, clinical autonomy, safety and quality, and viability of the system.
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- Introduction of stronger regulations to prevent selective and restrictive contracting.
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- Adoption of new technologies to support new models of care and reforms.
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- Increase in adoption of new technologies.
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| 3.5: Modernised procurement and regulatory processes ensuring patient access to essential prostheses and other medical technology and devices. |
- Effective implementation of prescribed list (formerly the prostheses list) reforms with close sector consultation to ensure medical practitioners can keep choosing the right device to suit their patients’ clinical needs.
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- Implementation of prescribed list reforms.
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- Regular review of the prescribed list to ensure the private health system is paying competitive prices for all medical devices and supports best-practice usage, with any savings passed on to consumers.
- Robust processes are established to ensure Australian patients have safe and cost-effective access to new and emerging medical technologies.
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- Implementation of a regular review cycle for the prescribed list.
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