3.1 Recalibrate the private health insurance policy levers around rebates, Lifetime Health Cover (LHC) loading, and Youth Discounts to account for the ageing demographic and changing insurance pool.
- A private health insurance system that offers affordable and appropriate cover within reach of all Australians.
- Enhanced levels of membership for younger Australians.
- Greater incentives to hold private health insurance among older Australians and existing policy holders.
- Measures to assist people, especially through the COVID-19 period by extending the age allowed under family policies, and pausing LHC loadings for those impacted by COVID-19 related losses.
- Increasing numbers of younger people taking up private health insurance hospital cover.
- Greater retention of existing policy holders.
- Reduced premium inflation due to a rebalanced and sustainable insurance pool.
|3.2 Engage in further policy reform to put greater value and protections into private health insurance in the eyes of consumers.
- A minimum threshold level of premiums returned to the health consumer as health benefits, i.e. payout ratio minimum of 90 per cent.
- A higher standard of transparency for private health insurance policies to clarify what benefit rates are, so patients can determine their out-of-pocket costs.
- Lower levels of variation between private health insurance rebates.
- An independent regulator to regulate the legal conduct of the private health insurance industry.
- Consider and adapt for the additional costs of responding to COVID-19 in the long term.
- Add private health insurance rebates on to the Commonwealth Government’s doctors’ fees (Medical Costs Finder) website.
- Reduced number of complaints to Ombudsman about benefits, membership and service.
- A greater proportion of premiums being paid towards benefits, not management expenses or profit taking, instilling greater consumer confidence in for-profit insurers.
- Protection against managed care, which has been shown to lead to increased costs.
- A higher standard of transparency for private health insurance policies to clarify benefits and reduced number of patients experiencing “bill shock”.
|3.3 Ensure patient choice and medical-led care remains central, while also developing new models of more efficient care and reducing low-value care.
- Invest in developing new medical-led, innovative models that will ultimately create new best-practice care. This should include adoption of new technology to support care provision, including community-level care where clinically appropriate.
- An independent regulator to oversee the legal conduct of the private health insurance industry and guard against insurer-directed care.
- Consider potential cost savings and efficiencies in other areas of outlays such as devices/prostheses.
- Increased number of medical services being carried out in the most clinically appropriate and efficient settings, including home-based care, community-based care and other non-admitted day programs.
- Ongoing efficiency and cost savings related to acute treatment.
|3.4 Hospital accreditation requirements for a fully empowered executive director of medical services (or equivalent) who is a registered medical practitioner with a Fellowship of RACMA, to have responsibility for clinical service delivery, safety/quality and credentialing within each hospital.
- Ensure appropriate training via RACMA or equivalent as a basis for all medical leadership roles.
- Medical responsibility for wellness and workplace culture within organisations recognised at executive level.
- Hospital accreditation to require further training for current medical leaders in management and healthcare policy, and identification of new medical leaders.
- Hospital accreditation process amended or introduced.
- Increase in appointments of Executive Director of Medical Services in line with these criteria.