Vision for Australia's Health

Pillar 3: Private Health

A reinvigorated and resilient private health system, which complements the public hospital system by providing high-quality, timely and affordable care in a sustainable way. Demographics, chronic disease, technology, and healthcare are all changing rapidly, and our policies must change accordingly. Having cleared the first hurdles for telehealth and home-based hospital care, we need to develop them further as part of a deliberate design of a better system. A system that provides the right programs which are cost effective, clinically advantageous, medical practitioner led and insurer funded. One that focuses on continual improvement – including, but not limited to prostheses reform, addressing the issue of private patients in public hospitals, new and improved clinician led models of care and the adoption of new technology. 


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.