Downloaded 38 times
More Related Content
Dr Rachel David
- 1. Putting consumers atthe centre of PHI reform: Balancing affordability and value July 27, 2017
- 2. Over 13.5 MillionAustralians Strong Who we are: • Australian private health insurance industry's peak representative body • Represents 20 health funds consisting of for-profit and not-for-profit health funds in Australia • Member funds collectively represents 96% of people covered by private health insurance
- 3. PHI is animportant part of Australia’s health ecosystem Private health, public benefit 37 13.5 $19.5 competing health insurance funds MILLION Australians (55%) rely on PHI for treatment when they need it BILLION in annual benefits paid to members 96% 2 of 3 86c of the PHI industry is represented by Private Healthcare Australia (PHA) non-emergency procedures are performed under PHI cover Australians get 86 cents back for every $1 premium paid, compared to only 66 cents in general insurance
- 4.
- 5.
- 6. Over 80% ofmembers find PHI to be good value for money Consumers regarding PHI cover as “very good” or “fairly good” value for money 80 84 78 82 76 86 88 90 Hospital Extras SOURCE: IPSOS consumer survey 2015 Percent
- 7. Question 7 n= 6,284 Which of the following aspects, if any, of the health system are most important for the government to address? 3% 8% 13% 14% 17% 18% 27% Helping compare health outcomes of medical professionals Helping compare OOP costs of medical professionals Eliminating waste and fraud Ensuring maximum value from healthcare spend Improving the quality of healthcare Improving access to healthcare Improving affordability of healthcare Aspect of health most important to address Again, #1 issue directly impacted by any moveon the rebate
- 8. Most people aresatisfied with their PHI, but affordability is a problem 6% 6% 6% 7% 7% 15% 48% 51% 72% Other How I gottreatedwhenIclaimed on myinsurance wasnotoptimal The processof contacting and communicatingwithmyinsureris difficult I receive toomanyseparate bills fromdifferentproviders I don’thave accessto health specialistsandhospitals I can use inmy region I’mnot coveredforareas expected or neededwithinmypolicy My premiumsare toohigh My out-of-pocketcostsfordental, alliedhealthandotherextrasare toohigh My out-of-pocketfeesand chargesfor medical specialists are toohigh SOURCE: PHA Consumer survey 2016, n=2,384 How satisfied are you with your private health insurance? Percent 3 3 10 36 33 15 Very Dissatisfied Somewhat Dissatisfied Somewhat Satisfied Satisfied Dissatisfied Very satisfied Why are you less than satisfied with your current private health insurance product? Percent times mentioned by those less than satisfied
- 9. The proportion ofspecialist services with out-of-pocket costs has been stable or declining over the past decade, but average costs are increasing SOURCE: Analysisof APRA (2016) Private Health InsuranceMedical Services 2005-2016 20 5 15 10 0 2008 2009 2010 30 20112007 35 2012 20162013 25 2014 2015 -3% p.a. Specialist services with gap in private hospitals1 Percent of services Average gap per service where gap is paid1 $ per service 400 200 600 0 800 2007 2009 2011 2014 20162008 2010 2012 2013 2015 +4% p.a. 1 For in-hospital medical services paid for by Privatehealth Insurers in servicegroups excluding consultations,anaesthetics,diagnostic imaging,pathology and ‘other items’. Does not includeall OOP costs associated with singleepisode
- 10. Many procedures havecharges within 200% of MBS rates, but charges for other procedures commonly exceed 300% 31% 13% 18% 2% 26% 6% 1%3% 0% 0% 150-175%<100% 125-150%100-125% 175-200% 200-225% 275-300%225-250% >300%250-275% 3%2% 1%5% 22%26% 31% 8%1%1% 9% 7%6%4%10% 18% 43% 1%1%1% 1 MBS item:32090 2 MBS item: 42702 3 MBS item: 49518 4 MBS item: 49318 5 MBS item: 16519 Cataract surgery2 Colonoscopy1 Management of labour and delivery5 Hip replacement4 SOURCE: HCP data collection 2014-15 Knee replacement3 27% 5% 5%5%8%2% 2% 45% 1%1% 1% 1%2%2% 0%0% 76% 1% 3% 16% Distribution of claims by chargeas a percent of MBS;Percentof claims
- 11. Consumers prefer toget information on expected OOP costs and quality online, and from their insurer SOURCE: PHA Consumer survey 2016, n=2,384 Expectedout of pocket costs of visiting various specialists or hospitals Averagequality (e.g. ratings) of healthcare providers Information documents that I can compare Online (incl. comparison websites) From my insurer 42 39 21 Through my GP Through a healthcare specialist (non-GP) 14 12 At a hospital 11 4 Governmentsponsored communication 11 Friends and family 18 8 6 20 52 25 6 12 Preferred sourcefor thefollowing information;Percent1 1 Respondents were allowed multipleresponses,so percentages sumto more than 100%
- 12. GP recommendation isthe most important factor for assessing the quality of providers 28% 39% 45% 60% 67% Specialist qualifications What my family doctor/ GP recommends Other patients' experiences Clinical quality metrics (e.g. number of procedures completed, number of re-admissions) Professional affiliations SOURCE: PHA Consumer survey 2016, n=2,384 What factors areimportantto you for measuring the quality of healthcare providers? Percent1 of time selected 1 Respondents were allowed multipleresponses,so percentages sumto more than 100%
- 13. Most people aresatisfied with their experience purchasing PHI, but some are confused by product features SOURCE: PHA Consumer survey 2016, n=2,384 How satisfied were you with your experience purchasing private health insurance? Percent 2 1 5 30 44 18Very satisfied Somewhat Dissatisfied Somewhat Satisfied Very Dissatisfied Dissatisfied Satisfied 10 12 13 23 25 28 29 35 45 Premiumswere toohighforthe productI wantedtopurchase Other Online informationwasdifficultto accessor use There wasno or poor supportavailable to answermyquestions There were toomanydifferentproduct typesthatwere confusing There were toomanyproductsto choose from Terminologyusedbydifferenthealth insurance providerswasconfusing Informationonproductinclusionsand exclusionswasdifficultto understand Couldn’tbuyacheapenough productto suitmybudget Why were you less than satisfied with your experience purchasing private health insurance? Percent times mentioned by those less than satisfied Inclusionand exclusioninformation isa particularissue for hospital product owners(33% of hospital onlyholders mentioneditasan issue,vs.13% of extrasonlyholders)
- 14. The last twodecades have seen an increase in the complexity of available PHI products 1 The increasein exclusionary products in June2010 is partly dueto a re-classification of policies between exclusionsand restrictionsby some insurers.Further, there is a break in the excess and co-payment data in June 2007 due to a change in the definition used. 30 60 20 10 0 50 70 80 40 Exclusions in policy Excess and/or co-payment 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 30 15 25 20 1999 2001 2003 2005 2007 2009 2011 2013 2015 Proportion of hospital cover policy holders with excess and/or co-payment or exclusions1 Percent Proportion of people not taking up private health insurance because ‘I don’t understand the different policies and it is just too hard’ Percent SOURCE: PHIAC (2015) Competition in the Australian PrivateHealth InsuranceMarket;IPSOS2015
- 15. Coverage levels shouldtake into account factors of importance to consumers 6% 2% 4% 5% 6% 6% 8% 9% 10% 12% 13% 18% Employer covers it Protection against high costs of care Receive Private Health Insurance rebate benefits Other Minimise Medicare Levy Surcharge Friends or family recommended it Reduced wait times for services Thought I should get it considering my age/family situation Minimise penalties under Lifetime Health Cover requirements Access to a wider choice of healthcare providers (e.g. specialists, hospitals) Access to higher quality healthcare providers (e.g. specialists, hospitals) To have control over the timing for a procedure if needed SOURCE: PHA Consumer survey2016, n=2,384 What is the main reason you purchased PHI? Percent Consumers value predictability, and treat- ment for urgent conditions Consumers value protection against high costs of care Consumers consider life- stage when taking up insurance
- 16. Limit- ations Government and privateproduct information channels both have limitations Government Private ▪ No recommendation or overallscore (policies of ‘bestfit’ with inputs) ▪ Difficult for consumers to use ▪ No information on expected out-of-pocket costs (e.g., impact of exclusions on OOP) ▪ Not all policies and health funds listed ▪ Variable clarity on inclusions and exclusions ▪ Advertised and sponsored results ▪ Differing formats for each health fund ▪ No information on expected out-of-pocketcosts Interface SOURCE: privatehealth.gov.au;iSelect.com.au; comparethemarket.com.au
- 17. Perceived service offeredby public and private hospitals Community View Section 4.6.1 Question A4(#5) n = 5,473 How would you rate GPs and the service they offer? 59 51 56 60 57 55 54 58 56 50 56 50 54 53 54 53 49 52 58 49 47 43 45 46 47 47 45 50 49 55 0 10 20 30 40 50 60 70 80 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 Rating of Service Offeredby Public and Private Hospitals % Rating Very High or Fairly High Private Public Public edges privatefor the firsttime
- 18. 4.3 4.2 5.1 4.6 4.2 5.1 5.2 4.8 5.6 5.9 5.45.4 5.4 4.8 0 2 4 6 8 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 Average Perceived Waiting Time for Treatment of Non-Life Threatening Ailment (Months) Section 4.7.2 Question D4 n = 2,741 If you or another member of your familyhad to go into a public hospitalfor treatment of an ailment which was not life-threatening, but was a cause of discomfort and pain, how long, if at all do you think you would have to wait to be admitted into a public hospitalin your area? Section 4.7.3 Question A17b(i) n = 2,269 From the time you discovered you required hospital treatment, how long did you have to wait before being admitted to this hospital? 57 49 72 84 84 81 74 103 97 119 103 32 22 37 44 39 39 39 57 52 59 59 0 20 40 60 80 100 120 140 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 Elective admissions: (Excluding Emergency Admission) Elective + Emergency Admissions (Including Emergency Admission) Average Reported Waiting Period for Treatment in Public Hospital (Days) Public hospital waiting times … perception versus reality Perception Reality (Reported) FACT: Averageelective waiting times have morethan doubled sinceturn of century
- 19. 35.8% 34.6% 34.8% 38.5% 16.9% 12.4%12.4% 14.5%13.5% 9.9% 10.0% 11.6% Scenario 1 (No change) Scenario 2 (25% Removal) Scenario 3 (75% Removal) Scenario 4 (100% Removal) Initial Demand (Very / Fairly Likely) Initial Demand (Very Likely) After Price prompt and MLS advice Very Likely (Stated) After Price prompt and MLS advice Demand (Forecast) Question 21 n =3,339 Which ofthe following aspects,ifany,ofthe healthsystem are mostimportant for the governmenttoaddress? Impact of rebate changes on NTM Demand 1.9% of uninsured Demand 1.2% of uninsured (-0.7%) Demand 1.4% of uninsured (-0.5%) Demand 1.5% of uninsured (-0.4%)
- 20. Rising input costshave an inflationary effect on PHI premiums Increase in PHI input costs in the last 12-24 months Hospital costs 7.6% in 2014/15 4.7% in 2015/16 Medical specialists 7.1% in 2014/15 3.0% in 2015/16 Medical devices 8.9% in 2014/15 5.4% in 2015/16 Allied health 6.3% in 2014/15 3.9% in 2015/16 Source: APRA
- 21. Further reduction inmedical device benefits Reduction in wasteful and low value care through payment integrity and the MBS review Changes to contracting rules & default benefits: consumer protection Lifetime Health Cover discount FOCUS ON AFFORDABILITY
- 22.
- 23.
- 24.