Recommendation 1
5.11 The
committee recommends that the Commonwealth Government undertake an evaluation
of the value provided by 'basic' policies as a fourth product category
(Gold/Silver/Bronze/Basic). Following that evaluation, the Commonwealth should
determine whether consumers are best served by a three-tier or a four-tier
product categorisation system.
Recommendation 2
5.18 The
committee recommends that the Minister for Health require private health
insurers to publish all rebates by policy and item number.
Recommendation 3
5.23 The
committee recommends that the Minister for Health instruct the Department of
Health to publish the fees of individual medical practitioners in a searchable
database.
Recommendation 4
5.26 The
committee recommends that the Commonwealth Government ask the appropriate body
(such as the Australian National Audit Office, Department of Health, Australian
Prudential Regulation Authority, Australian Competition and Consumer Commission
or the Private Health Insurance Ombudsman) to report in 12 months on whether
the benefits from the Prostheses List reforms are being passed on to consumers.
Recommendation 5
5.29 The
committee recommends that the Commonwealth Government provide additional
funding to the Private Health Insurance Ombudsman to enable it to widely
promote its upgraded website and comparison service to consumers.
Recommendation 6
5.34 The
committee recommends that all state and territory governments review policies
and practices regarding private patient election to ensure that all patients
can provide informed financial consent.
Recommendation 7
5.35 The
committee recommends that the Commonwealth Government and state governments
ensure that public hospitals provide equality of access for public and private
patients based only on clinical need and not on insurance status.
Recommendation 8
5.37 The
committee recommends that the issue of private patient adjustments be
considered in the context of negotiations on the next National Health Agreement,
consistent with the Minister's broader approach.
Recommendation 9
5.41 The
committee recommends that the Commonwealth Government consider extending the
Broader Health Cover provisions of the Private Health Insurance Act 2007
on the basis that such services, if offered, do not undermine the universality
of Medicare by creating a two-tiered primary health care system, do not inflate
costs for the Commonwealth by introducing another payer, are provided on a
comprehensive basis and do not delay treatment or lead to greater out-of-pocket
costs.
Recommendation 10
5.42 The
committee recommends that the Commonwealth Government review current
regulations to allow private health insurers to rebate out-of-hospital medical
treatment where it is delivered, on referral, in an out-patient, community or
home setting.
Recommendation 11
5.44 The
committee recommends that private health insurers engage in negotiations with
private hospitals and paediatric dentists to urgently resolve the issues
surrounding paediatric dentistry.
Recommendation 12
5.47 The
committee recommends that the Commonwealth Government amend relevant
legislation to prohibit the current practice of differential rebates for the
same treatments provided under the same product in the same jurisdiction.
Recommendation 13
5.49 The
committee recommends that the Australian Competition and Consumer Commission
reconsider whether private health insurers' use of data obtained from the
Health Industry Claims and Processing Service is anti-competitive.
5.50 The
committee also recommends the Commonwealth Government amend relevant
legislation to ensure there is a clear delineation between data obtained from
the Health Industry Claims and Processing Service and data used by health
insurers competing for services against other non-preferred providers. This
should extend to a requirement that such data be maintained strictly and
separately and that private health insurers should be prohibited from using
data gained through claims processes for commercial gain.
Recommendation 14
5.52 The
committee recommends that the Commonwealth Government require intermediaries to
disclose any commissions received from private health insurers for the service.
Recommendation 15
5.53 The
committee recommends that the Commonwealth Government amend relevant
legislation to require all private health insurers disclose executive
remuneration and other administrative costs.
Recommendation 16
5.55 The
committee recommends that the Minister for Health amend the legislation to
require private health insurers to provide adequate written notice of changes
to policies and eligibility to allow consumers to consider alternatives, and
that this notice clearly communicates changes to the policy that may affect the
insured person's coverage, especially where such changes may be detrimental.
Where relevant, the notice period should correspond to the eligibility period
for any service or treatment affected by the changes.
Recommendation 17
5.60 The
committee recommends that the Private Health Insurance Ombudsman advise the
Minister for Health in 2019 on additional measures that could be introduced to
make private health insurance easier to understand that are in addition to
significant reforms being introduced in 2018 and 2019.
Recommendation 18
5.61 The
committee recommends that the Australian Competition and Consumer Commission,
in consultation with the Private Health Insurance Ombudsman, commence work to
establish a new code of conduct that will provide the framework for engagement
between private health insurers and healthcare providers.
Recommendation 19
5.62 The
committee recommends that the Minister for Health write to the Private Health
Insurance Ombudsman to request advice on the disclosure of limitations to
treatment type or frequency which may arise from contract arrangements with
individual hospitals or providers that impact on members' access to services
and out-of-pocket costs.
Navigation: Previous Page | Contents | Next Page