Helping Consumers to Navigate
Change
Presentation to 13th Annual Health
Insurance Summit
28th July 2014
Samantha Gavel, Pr...
Private Health Insurance in Australia
 Over 10 million privately insured members;
 34 private health insurers (12 are re...
Standard Information Statement
Complaints and Disputes
0
500
1000
1500
2000
2500
3000
3500
4000
2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14
A...
Complaint Issues
0
200
400
600
800
1000
1200
Complaint Issues, 2011-12 to 2013-14
2011-12
2012-13
2013-14
Value of Complaints
 Most dissatisfied customers don’t
complain;
 Satisfied complainants become greater
advocates than t...
Good Complaints Handling
 An organisational culture that values feedback and
complaints;
 A complaints handling system t...
Unreasonable Complainant
Conduct
 Any behaviour by a current or former
complainant which, because of its
nature or freque...
Inappropriate and Unreasonable
Online Conduct
1. Monitor;
2. Evaluate;
3. Act;
4. Follow up and follow through;
5. Support...
Samantha Gavel - Private Health Insurance Ombudsman (PHIO) - Helping consumers to navigate change
Samantha Gavel - Private Health Insurance Ombudsman (PHIO) - Helping consumers to navigate change
Samantha Gavel - Private Health Insurance Ombudsman (PHIO) - Helping consumers to navigate change
Samantha Gavel - Private Health Insurance Ombudsman (PHIO) - Helping consumers to navigate change
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Samantha Gavel - Private Health Insurance Ombudsman (PHIO) - Helping consumers to navigate change

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Samantha Gavel delivered the presentation at the 2014 Health Insurance Summit.

The 2014 Health Insurance Summit focused on how legislative changes affect the future of health insurance in funding, membership and services.

For more information about the event, please visit: http://bit.ly/HISummit14

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Samantha Gavel - Private Health Insurance Ombudsman (PHIO) - Helping consumers to navigate change

  1. 1. Helping Consumers to Navigate Change Presentation to 13th Annual Health Insurance Summit 28th July 2014 Samantha Gavel, Private Health Insurance Ombudsman
  2. 2. Private Health Insurance in Australia  Over 10 million privately insured members;  34 private health insurers (12 are restricted access insurers);  5 largest insurers account for 82.3% of policies nationally;  552 private hospitals; 762 public hospitals;  17,675 health insurance policies available for sale (25,709 policies in total);  $13.16 billion in benefits in 2010/11.
  3. 3. Standard Information Statement
  4. 4. Complaints and Disputes 0 500 1000 1500 2000 2500 3000 3500 4000 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 All Complaints vs Disputes All complaints Disputes
  5. 5. Complaint Issues 0 200 400 600 800 1000 1200 Complaint Issues, 2011-12 to 2013-14 2011-12 2012-13 2013-14
  6. 6. Value of Complaints  Most dissatisfied customers don’t complain;  Satisfied complainants become greater advocates than those who’ve never complained;  Costs of complaints include loss of loyalty, negative opinions and damage to reputation;  Value of good complaints handling not just to customers, but also to staff.
  7. 7. Good Complaints Handling  An organisational culture that values feedback and complaints;  A complaints handling system that is accessible and responsive to customers;  Proper resourcing, recruitment and staff training;  Good complaint handling processes that facilitate timely investigation and resolution of complaints;  Analysis to identify and address systemic issues;  Regular review of the effectiveness and efficiency of the complaints handling process.
  8. 8. Unreasonable Complainant Conduct  Any behaviour by a current or former complainant which, because of its nature or frequency, raises substantial health, safety, resource or equity issues for the parties to a complaint.  UCC can happen anywhere. It is not limited to telephone communications or face-to-face interactions with complainants.  It can occur over the internet or on social networking websites, in a public location or in written correspondence.
  9. 9. Inappropriate and Unreasonable Online Conduct 1. Monitor; 2. Evaluate; 3. Act; 4. Follow up and follow through; 5. Support affected staff members.

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