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Private Healthcare Australia (PHA) is the Australian private health insurance industry’s peak representative body that currently has 20 registered health funds throughout Australia and collectively represents 96% of people covered by private health insurance. PHA member funds today provide healthcare benefits for over 12.9 million Australians.

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    The value of Private Health Insurance was highlighted today with the release of the Australian Medical Association’s 2017 Public Hospital Report Card. The report card found that waiting times for non-emergency surgery in Australia’s public hospitals have increased by 37%.


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    Statements by the Australian Greens today about the Private Health Insurance Industry are factually incorrect. Private Healthcare Australia CEO Dr Rachel David said consumer complaints about private health insurance have dropped significantly, the PHI rebate is keeping pressure off public hospitals, and Australians deeply value their private health cover.


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    Private Healthcare Australia has appointed industry expert and experienced CEO, Mr Rob Bransby as Chair of the PHA Board.

    PHA Chief Executive Dr Rachel David said the industry was extremely fortunate to retain Mr Bransby’s skills and experience following his retirement from his long term position as Managing Director of WA’s largest health fund, HBF.

    “Mr Bransby’s expertise in the industry is unparalleled and his continued involvement and contribution to the PHI reform process will be of great value to the Australian health system,” Dr David said.


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    Private Healthcare Australia Chief Executive, Dr Rachel David said, “The Consumer Health Forum’s collection of articles on private health insurance released today rehashes the same comments from people who have been critical of the sector for decades, including a number of out of touch commentators and academics. There is nothing new and there are no coherent solutions on offer.


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    Reform of medical device pricing is critical to affordability and sustainability of Australian health system.

    Private Healthcare Australia Chief Executive, Dr Rachel David said the Coalition Government’s ongoing commitment to reform medical device pricing would make health insurance more accessible and affordable for all Australians.


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    The Turnbull Government’s 2017-18 PHI Budget measures acknowledge the high value the community places on health care and recognises the importance of the private health insurance rebate. The reintroduction of Medicare Benefits Schedule indexation and the retention of the PHI rebate will improve healthcare affordability for all Australians.

    “The phased restoration of MBS indexation will reduce upward pressure on GP and specialist co-payments, which is a cost health fund members have been struggling with when they need a referral for treatment, or when they are billed by their chosen specialist. Out-of-pocket costs for medical specialist treatment are the biggest concern for health fund members when they need to access a health service,” said Private Healthcare Australia CEO, Dr Rachel David.


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    Private Healthcare Australia’s CEO, Dr Rachel David said the Senate Community Affairs Reference Committee has reaffirmed the industry’s long held position on prostheses pricing reform.

    “The recommendations of the inquiry in to “Price regulation associated with the Prostheses List Framework” endorse the private health insurance industry’s independent advice and if adopted will deliver significant savings for consumers on PHI premiums,” she said.

    Dr David said Recommendations 8 and 9 should be implemented as soon as possible to deliver savings to health fund members:


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    The value of Private Healthcare Insurance, particularly for younger Australians, was highlighted today with the release of Private Healthcare Australia’s Annual Survey Report of High Claims.

    Health funds paid more than $6.4 billion in benefits for individual claims (for which the benefit payment was over $10,000) during 2016, representing an increase of 6.7% compared to 2015. Nearly half of all payments for hospital treatment by Australian health funds (45%) are now for claims where the benefit payment for the episode of care was more than $10,000.

    “Many of these episodes involved hospital stays of more than 100 days for young Australians suffering from mental health issues, cancer and other conditions. Young people often think they’re invincible, but this data shows private health insurance is as important for those aged under 30 as it is for older Australians. It can be very difficult to get long-term treatment for conditions like PTSD and eating disorders in the public hospital system. Younger people who develop these conditions, or their families, can find themselves out of pocket by thousands of dollars if they don’t have private health insurance.”


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    Private Healthcare Australia’s CEO Dr Rachel David said health funds were committed to making it easier for their members to choose and use their health insurance and recognised that complexities had developed in the sector over time.

    “Private Healthcare Australia is working with the government and stakeholders through the PHI Reform process to improve specific features of the PHI system including standardised clinical terminology for all health funds to define exclusions, improvements to the privatehealth.gov.au website to help consumers navigate the system, and using a system of labelling products in tiers according to the level of value provided. This will require additional investment by the funds, but it is necessary to improve the customer experience.

    “More also needs to be done to improve health literacy in the community, so consumers are better able to assess their own health needs and make the right choices. Many of the health funds have useful information on their websites to help consumers with this, and it’s an area member funds are always looking to invest in,” she said.

    Dr David said a Choice survey reporting that Extras cover was not providing consumers with value was nonsense, as it was actually in increasingly valuable component of PHI.


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    State Governments are increasingly urging public hospitals to raise funds by using Private Health Insurance (PHI) funds as a cash cow, driving up the cost of premiums for all health fund members. Private Healthcare Australia CEO, Dr Rachel David, said the Department of Health discussion paper on private patients in public hospitals confirmed industry figures about the extent of the practice of cost-shifting by State Governments. “At a State level, a tacit encouragement of public hospital cost shifting has been growing. Some States have reduced funding for public hospitals and set quotas for “own-source revenue”, which is sought from a combination of PHI, veteran’s affairs, and other non-State Government funding,” said Dr David. “There has always been a stable number of private patients treated on an elective basis in public hospitals because of the nature of their condition, or because it is where their specialist works. What we are talking about here however, is the aggressive trawling of public emergency departments to try and convert as many patients as possible to private status.

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    The value of the Private Health Insurance Rebate has been reaffirmed by an independent study into the financing of Australia’s health system.

    The study, conducted by social policy research firm, Evaluate, concluded that at current settings, a dollar spent by the Government on the PHI Rebate is up to 15% more efficient than a dollar directed to the public system.

    This confirms that Federal Government expenditure on healthcare via the PHI rebate is an economically efficient method of spending, both in terms of direct economic costs and in overall welfare gains. It also shows that the Private sector and the PHI rebate are essential components or Australia’s highly successful ‘mixed’ health care system.


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    Keeping private health sustainable and premiums affordable ultimately benefits all Australians by keeping pressure off the public hospital system. Health funds have guaranteed all savings made by reducing inflated prostheses list benefits will be passed on to consumers by way of lower premiums and we urge the Government to continue the process of reform.

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    Australian health funds have demonstrated their commitment to improving the affordability and value of private health insurance for their members. Health funds have worked together with the Federal Government and private health stakeholders for close to two years to deliver a package of reforms aimed at putting downward pressure on premiums, and making it easier for consumers to choose and use their health insurance.

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    I am here on behalf of Private Healthcare Australia, the peak representative body for the private health insurance industry. We represent 20 health funds, both for-profit and not-for-profit. This covers over 96 per cent of Australians who hold private health insurance. This inquiry is important because 13.5 million Australians rely on private health insurance and more than half of them have disposable incomes under $50,000 per year. This is not a luxury market in Australia. We know that 84% of people believe that they get value for money from their private health insurance and cite peace of mind, choice of specialist for continuity of care, choice of hospital, and timing of medical treatment as the main reasons.

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    Private Healthcare Australia will bring together healthcare industry experts from across Australia to discuss the affordability, participation and value of private health insurance at a one day conference on 23 November, 2017.

    PHA Chief Executive Dr Rachel David said the conference coincided with the Government’s major PHI reform announcement, which many speakers had made a significant contribution to, and would set the agenda for stakeholder consultation during the coming twelve months.


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    Private Healthcare Australia has appointed highly respected and experienced Board Chair and Director, Julie-Anne Schafer as Chair of the PHA Board.

    PHA Chief Executive Dr Rachel David said the industry was fortunate to secure the skills and expertise of Ms Schafer who was extremely qualified to help guide the private health insurance sector through the implementation phase of the Government’s recently announced PHI reforms.


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    APRA’s 2016-17 Private Health Insurance Annual Report confirms that health funds are delivering value for 13.5 million Australian consumers.

    Funds paid a record $19.83 billion in benefits on behalf of their members ($14.75 billion for hospital treatment, $4.87 billion for general treatment and $220 million for State levies) in 2016-17. Health fund premium revenue increased by 4.6% in 2016-17 while fund benefits increased by 4.5%, demonstrating that the PHI claims ratio continues to outstrip comparable industries.


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    Private Healthcare Australia is urging a whole-of-sector commitment to transparency around issues such as specialist fees to bring the private health sector up to speed with the rest of the economy and consumer expectations.

    PHA Chief Executive Dr Rachel David said the latest APRA quarterly statistics (September 2017) highlighted an increase in out-of-pocket costs for consumers, which was contributing to a decline in private health insurance membership.


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    The value of private health insurance has been verified by the Health Care Complaints Commission 2016-17 Annual Report, which found that a patient in a public hospital is six times more likely to complain to the Commission than a patient in a private hospital.

    This is consistent with IPSOS research, which shows that 80% of Australians with private health insurance believe they get value for their money, and want to keep it.

    PHA Chief Executive Dr Rachel David said a Morgan Stanley report claiming the public hospital system was capable of handling all Australia’s medical needs was wrong and had failed to consider a range of factors involved in the health care experience.


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    Private Healthcare Australia’s CEO Dr Rachel David says the recommendations of the Senate Committee Report into the value and affordability of private health insurance and out-pocket-costs, are consistent with the reforms already being implemented under the Federal Government’s private health insurance (PHI) reform agenda.

    “It is encouraging to see that decision makers across the political spectrum have a genuine understanding of the importance of PHI in the Australian healthcare system and acknowledge that rising input costs, over which health funds have limited control, are the key drivers affecting affordability of premiums and out-of-pocket medical costs,” said Dr David.


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