People paying premiums for private health insurance face products that can leave them paying hundreds of dollars more, depending on their health fund, when they undergo the same procedure in the same hospital performed by the same doctor.
People paying premiums for private health insurance face products that can leave them paying hundreds of dollars more, depending on their health fund, when they undergo the same procedure in the same hospital performed by the same doctor.
The AMA this week released its annual Private Health Insurance Report Card calling on insurers to deliver value for money for policyholders. The report card said the challenges for private health insurers was to deliver better and fairer value for their policyholders, including the 235,699 new members with hospital cover, to try and ensure the membership uptick is not a flash in the pan.
AMA President Professor Steve Robson said the report found that the benefits paid for the uncomplicated delivery of a baby differed by $550 or 34 per cent from the lowest to the highest. For femoral or inguinal hernia surgery there is a $300 of 45 per cent difference.
"Two patients having the same operation done by the same surgeon in the same private hospital can find that there is up to a $700 difference in the amount they get back from their health fund.
"And that is a situation that has us scratching our heads. We don't think it is particularly fair for the people who spend a lot of money on their private health premiums and we think it's time it was really dealt with fairly," he said on ABC Radio Melbourne.
Professor Robson said on ABC's News Breakfast, "I think one of the big things that has happened over the pandemic with more customers joining up health funds because of the chaos in the public health system and less surgery being done, is it has been a profitable time for a lot of the health funds.
"And we have seen an increase of 16 per cent in what is called management fees - that is the sum of money that they take out of your premiums to run their health funds.
"So, we have seen some big increases across the board and we think that customers in Australia, patients, who are having medical procedures want value for money."
Professor Robson said the AMA was calling for an independent regulator - a Private Health System Authority - to oversee private health insurance to ensure policyholders were getting fair value for money through a mandated minimum amount that every insurer is required to return to patient care.
