The Australian Medical Association (AMA) and the private health insurance sector have been working hard to turn the Government’s proposal to lift penalties on middle-income earners without private health insurance into a major health system crisis.
Unfortunately for them — although perhaps fortunate for the Australian health system overall — the figures simply do not support their position. Despite the threats of imminent public health system collapse if private health fund membership decreases, health financing statistics reveal that private health insurance (PHI) plays only a minor role in the overall funding of our health system.
Australian Institute of Health and Welfare figures show that in 2005/06 PHI contributed only 7% of total health funding in Australia. Even if the AMA’s predicted one million people drop their cover as a result of the changes — and even if these one million people represent average health service users (very unlikely as those who drop their cover are expected to be lower level users) — the overall impact on health funding will be to reduce the contribution of PHI from 7% to about 6.2% of overall health funding.
Given that annual fluctuations in health funding frequently vary more than this without causing major problems, even the ‘worst case’ scenario painted by the AMA won’t bring the public health system to its knees.
To put the hype around this issue in perspective, consider the next largest source of health funding in Australia after PHI — direct consumer payments for health services. These now contribute over 17% of total health funding — more than twice as much as PHI — and yet receive scant media and policy attention.
This is unfortunate as the impact of these payments on consumers can have serious implications for the overall performance of our health system. Out-of-pocket payments often fall disproportionately on people with conditions which require regular health care with uninsurable gap payments and annual limits (such as GP and allied health services) or who use medications not covered by the PBS.
For example, people with Cystic Fibrosis often require regular physiotherapy and take a large number of (non-prescription) nutritional and digestive supplements on a daily basis. PHI is not an effective solution for people with conditions such as this, as even the highest level of PHI cover can still leave them with crippling out-of-pocket expenses. For example, the NRMA’s top extras cover “Extras Select Super Plus” imposes an annual $375 limit on rebates for physiotherapy. For someone requiring weekly physio treatment at $70 a session — there is not much “super” about this.
If the AMA and the private health insurance industry were genuinely concerned about the affordability of health care for consumers, they would be focussing on meeting the needs of people with chronic health conditions who currently incur high out-of-pocket payments. Reducing these costs, through minimising gap payments and entering into fee agreements between private health funds and doctors, would deliver much greater gains in terms of the affordability of health services than continued efforts to bribe and cajole people to take out PHI.
Increases in PHI numbers will not solve the problems within our health system and nor will a reduction in membership threaten its viability. The Government and the media should ignore the disingenuous postulating by the AMA and the health funds about the PHI changes and instead focus on the real issues affecting consumer access to health care.