Private Health Insurance Funds

Private-sector health insurance policyholders who do not receive good value for life from complicated policies: ADMA

Australian Medical Association has given a gloomy outlook on the country's private health insurers, stating that declining dues and increasing premium levels are jeopardising the sustainability of the health system as a whole. AMA gave its rating in its current business review on private health insurance. Michael Gannon, AMA Chairman, said that patient benefits were not good value for health and were bewildered by unnecessary complexity of guidelines that often did not offer adequate levels of coverage.

"We see year-on-year earnings gains for the profit-oriented health insurance companies while increasing the number of exclusions in their contracts. This shows that the number of appeals to the private health insurance ombudsman in 2016-17 rose by 30 percent compared to the previous year - the highest number of cases in a decade. 1,000 cases of complaint to the ombudsman in 2016-17 were registered.

Australia's biggest non-profit health funds, HCF, which is to fuse with Western Australia's biggest health funds, HBF, was the best performing health company on the AMA list. Gannon said the private healthcare system is an important part of universally provided healthcare, but insurance companies are not long-sighted. "I am aware that every single moment that we shed our lights on the failures of health insurance companies to provide a proper delivery, we are reducing the benefit promise of private health insurance, so we have to be very cautious about these issues every conversation," said Dr Gannon.

"Private clinics are involved, insurance companies are involved, Australian physicians are involved and no doubts about it, Australian clients are involved. "It is an important part of overall health care. "Private Healthcare Australia (PHA) - which has 20 health insurance companies in Australia - said the AMA's criticisms were unhelpful and denied its claim that customers were not getting value for money from their health insurance companies.

"However, one of the reasons and the only one why premium increases every year is that health insurance companies pay for more health. "Dr. David blamed the rise in health insurance claims on increasing pressure to cut costs. "In comparison with the number of cases in this industry, the number of complainants to the Ombudsman is extremely low.

"However, any proliferation of grievances is a matter of great importance to us. "Given that the household income has not changed, but health care expenditure has increased, this has resulted in an increased number of cases because cost is a problem and frustration with the system. "However, we enjoy working with and learning from the Ombudsman to make it easy for individuals to select and use their health insurance."