Transcript: ABC News Breakfast interview with AMA President Dr Danielle McMullen on the AMA Private Health Insurance Report Card 2025

Presenter:  Well, let's get a little bit more on that medical story now. And is private health insurance still worth the hefty premiums many Australians are paying? A new report suggests the overall value is eroding as private hospitals face mounting financial pressure. And to tell us more, the AMA President, Danielle McMullen, joins us now from Canberra. Danielle, thank you for coming on News Breakfast. The first thing that many of the viewers out there will be asking is, are we getting value for money? 

DR DANIELLE McMULLEN: It's a great question and unfortunately our report shows that that value for money is eroding and really calls for us to reform the system because that balance of public and private care is really what makes Australia's healthcare system unique and world leading. But we're starting to see such cost pressures in the private part and such underfunding of the public that the whole system really does need a lot more support to make sure Australians continue to get that great quality care. 

Presenter: So why are we in this situation of extreme strain? 

Dr McMullen: So, it's a number of factors. We've seen under-indexation of the Medicare schedule for decades, and that does actually underpin a lot of our private pricing. We've also seen private health insurers really bump up the premiums for their products far beyond wage price indexes, beyond CPI and beyond the cost of even health CPI. And so as a result of that, premiums, particularly high-quality gold ones, are getting out of reach for many Australians, and then we're seeing a lot of people underinsured. And that's what worries me as a doctor, is we've got patients who come in thinking they've got cover for procedures they might need, only to find out at the last minute they don't. But they just haven't been able to afford those higher coverage premiums. 

Presenter: We've heard from the Federal Health Minister, Mark Butler, who says that he expects insurers to make strenuous efforts to keep those premiums low. But insurers can get around it with a way called phoenixing. Can you explain what that is? 

Dr McMullen: Yeah, it's a pretty dodgy tactic that some of them have been employing where the minister is trying to keep premiums under track and has an annual process to do that. And then we're seeing some insurers just close products and then phoenix them back as a very similar product, but with a much higher price to escape that pricing that the health system tries to put in place. 

So we've called that out this year. It's not an acceptable practice and we do need all of our groups to come together and figure out what are we doing in this private health sector, how do we give patients affordability but also that confidence that their private health insurance is delivering them value. 

Presenter: OK, so that’s on a macro level, but as a consumer, what can we do? Is it time to make a better health check on our own policies? 

Dr McMullen: It's really a good reminder to go have a look at what your policy is, and if you've got a bronze or basic policy, just being aware that you may not be covered for a number of procedures. Shop around, and also our private health insurance report card gives you a bit of insight into the fact that different policies will pay different amounts for similar procedures. So having a look, making sure you're getting value for money and shopping around if you need to. 

Presenter: And what are you calling for in terms of the amount of money that actually goes back into paying and also oversight as well? 

Dr McMullen: So we want to see 90 per cent of premiums back into delivery of care. We've seen insurers rack up management expenses and profits that they shouldn't be. And so, we'd like to see that 90 per cent back. And then some oversight of the system with what we would call a private health system authority. And that's where we could get insurers, hospitals, doctors, consumers together in a room to make sure that we've got fit for purpose regulation and that we design a private health system that's fit for the needs of Australians today and into the future. 

Presenter: And Danielle, while we've got you on the program, there have been reports that as a result of the Albanese government's Medicare boost, there have been an extra four million visits to GPs that are now bulk billed. How do you think that is rolling out at the moment in terms of people being able to actually get in and access doctors more affordably? 

Dr McMullen: As I think we expected, it's different in different parts of the country and it's fantastic to see that some more patients who need low or no out-of-pocket costs are able to get that with these extra incentives. So, we know that this really helps people in disadvantaged areas. We know that in other parts of the country, we still need reforms to make sure that you can get those longer consultations with your GP, get that preventive care and that chronic disease management that needs those few extra minutes. But it is good to see that this is providing some short-term support for people.   

Presenter: Yes, it's definitely those longer consultations and saving money in the long run, isn't it, to avoid them from actually going into the hospital system. 

Dr McMullen: Exactly. 

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