The document discusses ways to reform private health insurance (PHI) in Australia to better balance affordability and value for consumers. It provides background on the PHI industry and findings from consumer surveys. Key points include: consumers value predictability and treatment for urgent conditions but affordability is a major issue; online sources and health funds are preferred for information but have limitations; and changes are needed to simplify complex products and address rising costs while maintaining coverage levels important to consumers like protection from high costs.
Each year, Jackson Healthcare studies trends impacting physicians' careers and medical practices.
We hope this information helps physicians make more informed, strategic decisions. And we hope these statistics help healthcare executives, industry thought leaders and media professionals better understand the attitudes, challenges and opportunities physicians face.
This presentation shares highlights from our 2014 national survey of U.S. physicians.
Presentation Zeroes in on Successful CIN PYA, P.C.
Building a clinically integrated network (CIN) that brings together a hospital and community physicians, does not have to be a long, difficult process.
In a presentation given at the 2014 AHLA Physicians and Hospitals Law Institute, PYA Principal David McMillan, Flagler Hospital Chief Operating Officer Jason Barrett, and Smith Hulsey & Busey Attorney Shareholder Charmaine T. Chiu followed one healthcare community’s journey to form a CIN in nine months.
This report collects data, surveys and commentary on U.S. physicians. It includes data on supply & demand, regulatory impacts, compensation & reimbursement, outlook & satisfaction, practice environment and employment.
mHealth Israel_Mony Weschler_Montefiore_How Data Exchange Is Essential In Sup...Levi Shapiro
Presentation for mHealth Israel by Mony Weschler, Senior Director Applications Strategy and Innovation, Albert Einstein College of Medicine, Montefiore Medical Center. Theme: How Data Exchange Is Essential In Support of New Technologies & Healthcare Innovation. This presentation has three objectives:
1) Discuss IT governance components that positioned Montefiore to achieve extensive community outreach efforts
2) Review strategies for incorporating innovation and new technologies into existing processes.
3) Identify the data exchange challenges
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...Levi Shapiro
Presentation for mHealth Israel by Jeremy Brody, EVP Corporate Development, Kantar Health: Health consumers are Not All created equal- the Role of the Chief Health Officer (CHO)
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...NHS Improvement
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
Medicines Management Pharmacist (NHS Hampshire)
Independent Prescriber (Victoria Practice, Aldershot)
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
FTC Spring Privacy Series: Consumer Generated and Controlled Health DataBrian Ahier
Increasingly, consumers are taking a more active role in managing and generating their own health data. For example, consumers are researching their health conditions and diagnosing themselves online. Consumers are also uploading their information into personal health records and apps that allow them to manage and analyze their data, and utilizing connected health and fitness devices that regularly collect information about them and transmit this information to other entities.
The movement of health data outside the traditional medical provider context has many potential benefits; however, it also raises potential privacy concerns. The seminar will address questions such as:
What types of websites, products, and services are consumers using to generate and control their health data, and how are consumers using them?
Who are the companies behind these websites, products, and services, what are their business models, and what does the current marketplace look like?
How can consumers benefit from these companies’ websites, products, and services?
What actions are these companies taking to protect consumers’ privacy and security?
What do consumers expect from these companies regarding privacy and security protections?
Do consumers differentiate between these companies and those that offer traditional medical products and services that are covered by HIPAA?
What restrictions, if any, do advertising networks and others impose on tracking of health data?
Professor Liam Smeeth: Big Data, 30 June 2014Nuffield Trust
In this slideshow, Liam Smeeth, Deputy Director and Head of Department of Non-Communicable Disease Epidemiology of the London School of Hygiene and Tropical Medicine discusses big data, e-health and the Farr Institute.
Liam Smeeth spoke at the Nuffield Trust event: The future of the hospital, in June 2014.
mHealth Israel_Chinese Healthcare System and Israel Startup Opportunity_Donal...Levi Shapiro
Presentation for mHealth Israel by Donald Tang, Managing Partner, Shanghai Creative Investments, May 25, 2016 in Tel Aviv. Overview of Chinese Healthcare System and Israel Startup Opportunity; China is An Extremely Large Health Care Market; Significant Demand over Supply; Extremely Weak Local R&D; In dire need to incorporate with high-end
technologies; Major Changes are happening; SCI is helping the paradigm shifting; What an Israel Start-up can do?
Palestra de Rachel David no 3º Fórum Nacional da Saúde Suplementar, realizado pela Federação Nacional de Saúde Suplementar (FenaSaúde), no Sheraton WTC São Paulo Hotel, no dia 6 de outubro de 2017.
Each year, Jackson Healthcare studies trends impacting physicians' careers and medical practices.
We hope this information helps physicians make more informed, strategic decisions. And we hope these statistics help healthcare executives, industry thought leaders and media professionals better understand the attitudes, challenges and opportunities physicians face.
This presentation shares highlights from our 2014 national survey of U.S. physicians.
Presentation Zeroes in on Successful CIN PYA, P.C.
Building a clinically integrated network (CIN) that brings together a hospital and community physicians, does not have to be a long, difficult process.
In a presentation given at the 2014 AHLA Physicians and Hospitals Law Institute, PYA Principal David McMillan, Flagler Hospital Chief Operating Officer Jason Barrett, and Smith Hulsey & Busey Attorney Shareholder Charmaine T. Chiu followed one healthcare community’s journey to form a CIN in nine months.
This report collects data, surveys and commentary on U.S. physicians. It includes data on supply & demand, regulatory impacts, compensation & reimbursement, outlook & satisfaction, practice environment and employment.
mHealth Israel_Mony Weschler_Montefiore_How Data Exchange Is Essential In Sup...Levi Shapiro
Presentation for mHealth Israel by Mony Weschler, Senior Director Applications Strategy and Innovation, Albert Einstein College of Medicine, Montefiore Medical Center. Theme: How Data Exchange Is Essential In Support of New Technologies & Healthcare Innovation. This presentation has three objectives:
1) Discuss IT governance components that positioned Montefiore to achieve extensive community outreach efforts
2) Review strategies for incorporating innovation and new technologies into existing processes.
3) Identify the data exchange challenges
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
mHealth Israel_Kantar Health_Jeremy Brody, EVP Corporate Development, Health ...Levi Shapiro
Presentation for mHealth Israel by Jeremy Brody, EVP Corporate Development, Kantar Health: Health consumers are Not All created equal- the Role of the Chief Health Officer (CHO)
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...NHS Improvement
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
Medicines Management Pharmacist (NHS Hampshire)
Independent Prescriber (Victoria Practice, Aldershot)
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
FTC Spring Privacy Series: Consumer Generated and Controlled Health DataBrian Ahier
Increasingly, consumers are taking a more active role in managing and generating their own health data. For example, consumers are researching their health conditions and diagnosing themselves online. Consumers are also uploading their information into personal health records and apps that allow them to manage and analyze their data, and utilizing connected health and fitness devices that regularly collect information about them and transmit this information to other entities.
The movement of health data outside the traditional medical provider context has many potential benefits; however, it also raises potential privacy concerns. The seminar will address questions such as:
What types of websites, products, and services are consumers using to generate and control their health data, and how are consumers using them?
Who are the companies behind these websites, products, and services, what are their business models, and what does the current marketplace look like?
How can consumers benefit from these companies’ websites, products, and services?
What actions are these companies taking to protect consumers’ privacy and security?
What do consumers expect from these companies regarding privacy and security protections?
Do consumers differentiate between these companies and those that offer traditional medical products and services that are covered by HIPAA?
What restrictions, if any, do advertising networks and others impose on tracking of health data?
Professor Liam Smeeth: Big Data, 30 June 2014Nuffield Trust
In this slideshow, Liam Smeeth, Deputy Director and Head of Department of Non-Communicable Disease Epidemiology of the London School of Hygiene and Tropical Medicine discusses big data, e-health and the Farr Institute.
Liam Smeeth spoke at the Nuffield Trust event: The future of the hospital, in June 2014.
mHealth Israel_Chinese Healthcare System and Israel Startup Opportunity_Donal...Levi Shapiro
Presentation for mHealth Israel by Donald Tang, Managing Partner, Shanghai Creative Investments, May 25, 2016 in Tel Aviv. Overview of Chinese Healthcare System and Israel Startup Opportunity; China is An Extremely Large Health Care Market; Significant Demand over Supply; Extremely Weak Local R&D; In dire need to incorporate with high-end
technologies; Major Changes are happening; SCI is helping the paradigm shifting; What an Israel Start-up can do?
Palestra de Rachel David no 3º Fórum Nacional da Saúde Suplementar, realizado pela Federação Nacional de Saúde Suplementar (FenaSaúde), no Sheraton WTC São Paulo Hotel, no dia 6 de outubro de 2017.
In October 2014, INTEGRATED's Bill Jessee presented "Where Is Healthcare Going? And How Will We Get There?" at Iowa Hospital Association's annual meeting. The presentation focuses on the forces shaping healthcare today, the delivery system changing in response to the environment, and what this all means for hospitals and physicians.
As pharmaceutical and biopharmaceutical manufacturers are receiving more attention, legal scrutiny and activity from government and other entities regarding various components of their patient support services programs, this survey analyzes responses from close to 30 small, mid-size, and large pharmaceutical organizations (9 of the Top 20 pharmaceutical companies) to provide insights as it relates to risk mitigation and emerging strategies for managing patient interactions in a compliant manner.
Primary care in the New Health Economy: Time for a makeover.PwC
According to PwC's Health Research Institute's report, “Primary care in the New Health Economy: Time for a makeover”, primary care is set to make a comeback in the New Health Economy -- with a newfangled twist. Technology, consumer-friendly new entrants and care teams that rely less on a single physician are leading the way to a reimagined primary care system, poised to deliver better value to today’s demanding purchasers and close the gap on projected physician shortages.
James G. Kahn, MD, MPH
Pharmacy Leadership Institute
Kaiser Permanente Development Program
Debate on Health Care Reform
Youtube: http://youtu.be/2ed0qRXMRBE
Medibank Managing Director speaks at Amercian Chamber of CommerceLaura Harris
Medibank Managing Director, George Savvides presented at the American Chamber of Commerce in Melbourne about Medibank’s approach to primary care and its integrated care pilots.
As part of the global agenda of insuring for sustainable development, the Facility and the PSI Initiative organize a webinar series with the theme, “Making inclusive insurance work”. The sixth webinar had the topic "Health insurance for the emerging consumer" and was held on 5 July 2017.
Speakers during this webinar were: Lorenzo Chan (Pioneer Group), Sanjay H. Pande (Finsall Networks) and Walter Bacareza (PhilHealth). Moderator: Lisa Morgan (ILO's Impact Insurance Facility).
Telehealth and telemedicine have been widely used to deliver healthcare services like patient/clinician contact, disease prevention and curative care, advice, reminders, education, monitoring, and remote admissions. This presentation covers
- What is Telehealth
- Difference between Telehealth and Telemedicine
- The market of Telehealth
- The problem/need gap it solves
- The attitude of clinicians and patients towards Telehealth
- Telehealth benefits and limitations
- Telehealth services/modalities
- Adoption stages
- Telehealth Case study
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
the IUA Administrative Board and General Assembly meeting
Dr Rachel David
1. Putting consumers at the centre of PHI
reform:
Balancing affordability and value
July 27, 2017
2. Over 13.5 Million Australians 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 an important 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
6. Over 80% of members 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 are satisfied 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 of specialist 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 have charges 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 to get 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 is the 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 are satisfied 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 two decades 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 should take 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 private product 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 offered by 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
5.4 5.4 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 costs have 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 in medical 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