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Private health insurance report welcomed by Australian Dental Association and Consumers Health Forum of Australia

Dentistry, The Business of Health, The Health Industry

The Australian Dental Association (ADA), has commended the Senate Community Affairs References Committee report on the value and affordability of private health insurance and out-of-pocket medical costs.

The ADA says that this report could settle the unfair practices of private health insurers in the dental services and dental insurance market.

ADA Federal President, Dr Hugo Sachs said, “We applaud the Committee for addressing many of the ADA’s concerns and making recommendations to ensure greater transparency, genuine choice of provider and equitable rebates for dental consumers, and a fairer, more level competitive playing field for dental health care providers”.

The organization praised the amendment of the Private Health Insurance Act to prohibit differential rebate rates based on the health fund contract on health care providers.

Additionally, ADA expressed high appreciation for the recommendation to require the publication of rebate details for all treatment items covered in the health fund.

“Policyholders who have resisted pressure from their health fund to give up the continuity and quality of care they receive from their regular independent dentist, have often received rebates that are hundreds of dollars lower than those their health fund pays for the same treatment provided by a fund contracted dentist.” said Dr Sachs.

The Consumers Health Forum of Australia (CHF), also expressed support of the recommendations drafted in the report, stating that this move represents a great step to a more consumer-friendly system.

Leanne Wells, CEO of the CHF stated, “We strongly support many of the committee’s 19 recommendations in this ground-breaking report which recognises that the system must meet the needs of the consumer – those who pay for health insurance policies – and not vice versa.”

Ms Wells also noted the recommendation for the Government to consider extending private cover in some circumstances for services outside hospitals.

“We think that while there may be sound reasons for moving in that direction particularly if this is a way to deliver better value to consumers from their policies, we agree with the committee that such changes should only be made on the proviso that services would not undermine the universality of Medicare by creating a two-tiered primary health care system, do not inflate costs and are provided on a comprehensive basis.”

The 19 recommendations from the report are:

  • evaluating the value provided by ‘basic’ policies as a fourth product category and determining the best product categorisation system
  • requiring the private health insurers to publish all rebates by policy and item number
  • instruction of the Department of Health to publish the fees of individual medical practitioners in a searchable database
  • asking the appropriate body to report in 12 months on whether the benefits from the Prostheses List reforms are being passed on to consumers
  • providing additional funding to the Private Health Insurance Ombudsman
  • requesting all state and governments to review policies and practices regarding private patient election
  • ensuring that public hospitals provide equality of access for public and private patients based only on clinical need and not on insurance status
  • considering the issue of private patient adjustments in the context of negotiations on the next National Health Agreement
  • extending the Broader Health Cover provisions of the Private Health Insurance Act 2007
  • review current regulations to allow private health insurers to rebate out-of-hospital medical treatment where it is delivered’
  • engaging private health insurers in negotiations with private hospitals and paediatric dentists to urgently resolve the issues surrounding paediatric dentistry
  • amending relevant legislation to prohibit the current practice of differential rebates for the same treatments provided under the same product in the same jurisdiction
  • reconsidering whether private health insurers’ use of data obtained from the Health Industry Claims and Processing Service is anticompetitive
  • amending 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
  • requiring intermediaries to disclose any commissions received from private health insurers for the service
  • amending relevant legislation to require all private health insurers disclose executive remuneration and other administrative costs
  • amending the legislation to require private health insurers to provide adequate written notice of changes to policies and eligibility to allow consumers to consider alternatives
  • developing additional measure to make private health insurance easier to understand
  • commencing work to establish a new code of conduct that will provide the framework for engagement between private health insurers and healthcare providers
  • requesting advice on the disclosure of limitations to treatment type or frequency that impact on members’ access to services and out-of-pocket costs

In My Health Career’s article published in November 30 last year, various health and medicine organizational bodies also provided their two cents on the reform of the Private Health Insurance policies.

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