AMA: Insurers’ changes will cut choice of care


The cost of private health insurance will rise again on Sunday 1 April – and Australians are being warned that their choice of healthcare could be reduced due to new plans by major insurers.

While the federal government is seeking to reform the health insurance industry and bring clarity to policies, Bupa announced this month it will remove 'no gap' cover for certain hospital treatment.

The Australian Medical Association (AMA) said this could mean significant out-of-pocket costs for patients, and that they are unable to choose the doctors and hospitals most suitable for their care.

AMA president Michael Gannon accused big insurers of pursuing “a US-style managed care agenda to save costs and further increase profits by making it harder for patients to receive care from the doctor they want in the most appropriate hospital for their condition”.

Launching the AMA's 2018 Private Health Insurance Report Card, Dr Gannon said Bupa's new policies will only provide maximum benefits for patients in hospitals that have contracts with the insurer.

“Public confidence in private health insurance is already at an all-time low. These changes will
further devalue policies, which are a major financial burden for Australian families, and will
place dangerous pressure on the already-stressed public hospital system,” he added.

The AMA's report claims that many private insurance policies do not provide the cover that patients expect – and operations are often cancelled at the last minute when doctors discover the shortfall in funding.

“If people have one of these ‘junk policies’, they should consider carefully what cover they really need,” Dr Gannon said.

“The government has undertaken some important reforms to private health insurance to help people understand the different conditions that each policy category – gold, silver, bronze, and
basic – will cover. The funds must not be allowed to sabotage these reforms,” he added.

Labor's Shadow Minister for Health and Medicare Catherine King highlighted statistics in the AMA report showing that the private health insurance industry's pre-tax profits had more than doubled in the past decade – as had complaints received by the sector's ombudsman.

"This data is just more evidence of the need to act to make private health insurance fairer for Australians and shift the balance back to consumers,” Ms King said.

She said Australian families are paying around $1,000 more every year for private health insurance and the proportion of policies with exclusions has soared to more than 40 percent.

Consumer group Choice says health insurance premiums have increased 70 percent in the past decade, with a growing number of exclusions in the fine print, but warned people not to downgrade from a top-level policy in order to save money.

“Although it might reduce the premium cost in the short term, it can ultimately compound your hip-pocket pain,” Choice spokesman Tom Godfrey said.

“If you decide to go private, it pays to be aware of exactly what you’re getting in terms of cost, coverage and value for money,” he added.

Read more: AMA calls for private health insurance reform


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