AMA Submission on Private Health Insurance premium round process calls for transparency and independent regulator

Australian Medical Association

The AMA has again called for PHI premiums increases to be set by an independent Private Health Systems Authority.

In its submission to the Department of Health and Aged Care (DoHAC) consultation on the annual premium round for private health insurers, the AMA has argued that there are some relatively simple changes that could be made to address current inadequacies in the premium round process.

For example, the submission argues it is essential DoHAC collects and considers additional information as part of the assessment, including information on actual benefits paid, premium revenue collected, and the price of old products closed and new products released during the previous premium year.

The AMA has also called for increased transparency of communication of premium round outcomes to the public. Consumers would benefit by knowing the average change by insurer by product type and the range of percentage increases to individual policies by each insurer.

Moreover, the submission argues these changes will mean little without broader reform of the private health system to address issues of private hospital viability and value for consumers and to drive the adoption of new models of care.

The AMA believes there is a need for an independent and well-resourced regulatory mechanism – a Private Health Systems Authority – to oversee the private healthcare system and ensure its long-term sustainability.

Such an authority would ensure a cohesive and holistic regulatory model by relieving the department of its conflicted role as a regulator and policy maker and incorporating new functions to fill the gaps in the current regulatory environment.

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