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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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    Health funds are playing an increasingly important role in ensuring Australians have access to high quality dental care, according to Private Healthcare Australia Chief Executive, Dr Rachel David.

    “In Dental Health Week it is worth noting that health funds are paying more than ever before for dental services in Australia, and more than both the Federal and State Governments. APRA’s latest dental service data reported that more than 41 million dental services were funded by health funds in the 12 months ending March 2018.


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    The Senate’s decision to pass the Private Health Insurance reforms today signals widespread support for Australian health funds’ commitment to work with government, hospitals, consumers and specialist doctors to improve the affordability and value of PHI for 13.5 million members.

    PHA Chief Executive, Dr Rachel David said this was an important day for Australia’s health care system as the PHI reform package would improve transparency in private health, and make it easier for consumers to choose and use their health insurance.


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    Private Healthcare Australia CEO Dr Rachel David said the AMA’s scaremongering about health funds accessing My Health Record data, demonstrates an astonishing level of ignorance about how private health insurance operates.

    Private health insurance is based on the principle of ‘community rating’, which means consumers pay the same premium for the same policy regardless of their current or potential health status.


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  • 09/13/18--20:37: The Truth about PHI Reform
  • Private Healthcare Australia CEO Dr Rachel David said a media report in News Ltd publications about a leaked Deloitte document was completely wrong and an example of ‘fake news’.

    “For the record, the so called leaked modelling was rejected months ago by health funds, the Department of Health and the Private Health Ministerial Advisory Council.

    “The Opposition would do well to check a few facts before regurgitating fake news about Australian health funds.


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    Private Healthcare Australia CEO Dr Rachel David says the Morrison Government’s Productivity Commission Inquiry into mental health should investigate options to increase funding and support for models of care in the community.

    Private health insurance is a major funder of mental health care in Australia. Health funds pay for 76% of same day mental health treatments and 56% of all mental health care type admissions. There has been dramatic growth in mental health day admissions over the last decade and the percentage of young Australians presenting to hospital with mental health conditions is increasing by 10% per year.


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    Private Healthcare Australia Chief Executive Dr Rachel David said new private health insurance rules announced by the Government today will make it easier for consumers to choose and use their health cover.

    “Australian consumers have asked for a PHI system which is easier to understand and more transparent and the Gold, Silver, Bronze, Basic classification system will deliver that,” said Dr David.

    “This reform is a key feature of the PHI package of reforms and will classify existing policies into easy to understand tiers. The system is designed to reflect as much as is possible the spread of products already in the market, however it will eliminate features of the system that consumers have found confusing, improve transparency and make it simpler for consumers to use their PHI.


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    PHA’s Annual High Claims 2018 Report demonstrates the value of having private health insurance, particularly for younger Australians, but it also highlights the impact medical device costs and long hospital admissions for mental health problems are having on claims.

    The report reflects the latest APRA 2017/18 data that shows prostheses (medical device) benefits paid by private health insurers have increased considerably over the past five years across major disease groups such as cardiac and musculoskeletal procedures (which covers hip and knee, foot and ankle, shoulder and elbow, hand and spine).


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    Health funds paid a record $20.5 billion in benefits on behalf of their members in 2017-18, an increase of 3.4% on the previous year, according to the latest APRA Report.

    Private Healthcare CEO Dr Rachel David said APRA’s Operations of Private Health Insurance Annual Report 2017-18, confirmed that health funds are delivering real value to more than 13.5 million members.

    “Health funds are paying more for healthcare services and continue to consistently pay 86 cents in the premium dollar back to members to fund their healthcare. Health funds pay the highest percentage back to customers of all insurance types - it has been above 85% for 16 years,” said Dr David.


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    Benefits paid by health funds on behalf of their members increased by 3.62% to reach a record $20.4 billion in the year to September 2018.

    Private Healthcare Australia Chief Executive Dr Rachel David said the latest data released by APRA demonstrated the ongoing commitment of Australian health funds to addressing the value of private health insurance for consumers.

    In the September quarter, total benefits paid increased by 3.62% while premium revenue increased by 3.31%. Net margin has decreased from 5.52% to 5.18% and net profit for the year to September 2018 was $1.41 billion, down 1.4% compared to same time in the previous year.


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    Premiums have increased because more claims are being paid, not because of retained capital or excess profits

    Private Healthcare Australia’s Chief Executive Dr Rachel David said APRA’s review of capital standards for private health insurers was designed to ensure health funds retained sufficient capital to protect their members.

    APRA has emphasised that capital levels in the industry are appropriate and do not need to be reduced and that “any changes to the capital framework are unlikely to materially affect premiums; claims costs, rather than capital levels, have been the primary driver of health insurance premium rises over recent years.” (Geoff Summerhayes, APRA).