Health Insurance

2022 - 12 - 20

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Image courtesy of "The Guardian"

Younger Australians increasingly taking out private health insurance ... (The Guardian)

Report finds variation of up to $700 in rebates paid to patients of different funds undergoing same procedure by same doctor in same hospital.

When people look at the health system and read about all of the pressures on it during the pandemic, they think ‘I’ll take out private health insurance to get in front of the queue’. “With insurers’ expenditure on management expenses and profit margins remaining generously high we want to see the money that patients pay in premiums fund their health care – not increased profits for insurers. [Private Health Insurance Report Card for 2022](https://www.ama.com.au/articles/ama-private-health-insurance-report-card-2022) found a continued two-year upward trend in membership, with the proportion of people with hospital insurance rising from 43.6% in June 2020 to 45.2% by June 2022. The AMA, however, said the private system, which covers 40% of Australia’s hospitalisations and performs two-out-of-three elective surgeries, is crucial to keep pressure off public hospitals. “We need huge, system-wide reform of health funding particularly to support those with chronic illness, which is an area private health insurers don’t really want to know about.” Because if you’re young and healthy you’re subsidising anyone over the age of 55, which is the age at which you become a net beneficiary”.

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Image courtesy of "Australian Medical Association"

Private health insurers with big profits and high management ... (Australian Medical Association)

Private health insurer profits are up on the back of increased member numbers and reduced elective surgeries, with management expenses for executive ...

“One of the main reasons we produce this report card is to help consumers navigate the complex private health system by helping them to understand fees and the factors that cause out-of-pocket costs. “With insurers’ expenditure on management expenses and profit margins remaining generously high we want to see the money that patients pay in premiums fund their health care — not increased profits for insurers. “When management expenses are gobbling up premiums, there is less money for members’ claims for hospital treatments. For femoral or inguinal hernia surgery there is an $300 or 45 per cent difference. “This variation in out-of-pocket expenses is one of the reasons the AMA has called for an independent regulator — a Private Health System Authority — to oversee private health insurance to ensure policyholders are getting fair value for money through a mandated minimum amount that every insurer is required to return to patient care.” Professor Robson said the challenge for private health insurers now was to deliver better value for money to their policyholders — including the 235,699 new members with hospital cover, to try and ensure the membership uptick is not a flash in the pan.

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Image courtesy of "ABC News"

Are private health insurance customers paying more for less? (ABC News)

The Australian Medical Association's president Steve Robson breaks down his organisation's annual analysis of health funds.

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Image courtesy of "7NEWS.com.au"

Rebates offered by Australian health insurers can differ by more ... (7NEWS.com.au)

The difference in the amount of money Australian health insurers fork out for the same procedure can vary by as much as $700.

The largest disparity in rebates, however, was for patients seeking treatment for a hernia. For a complicated delivery, this figure is $511.60 or 20.5 per cent. “They are also a good reason to look beyond just the price of the annual premium levels of an insurer to ensure that you get value for your insurance policy.” For a coronary artery bypass operation the difference between the top insurer (AHSA) and the one paying the least (nib) was $747.35. There was a 37 per cent difference in the rebate from Australian Health Service Alliance ($964.70) and nib ($663.75). For an uncomplicated delivery of a baby, the biggest rebate on offer is $550.35 (29 per cent) more than the lowest.

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Image courtesy of "Yahoo Finance Australia"

$700000: Australia's most expensive health insurance claims (Yahoo Finance Australia)

Hospital stays can be expensive, but some far outweigh others. One of Australia's biggest health insurers has revealed the most expensive claims this year.

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Image courtesy of "Kaiser Family Foundation"

Experiences with Health Care Access, Cost, and Coverage ... (Kaiser Family Foundation)

This report presents findings from the 2022 KFF Women's Health Survey (WHS) on women's health status, use of health care services, and costs.

Larger shares of women with low incomes (18%) and those who are uninsured (22%) say their telehealth care was better than in-person care than women with higher incomes (10%) and those with private insurance (10%). Among the 27% of women and 23% of men who have had problems paying medical bills in the past 12 months, similar shares have had to set up a payment plan to pay off the bill (65% of women and 68% of men); used up all or most of their savings (62% of women and 69% of men); been contacted by a collection agency (61% of women and 56% of men); and had difficulty paying for basic necessities (52% of women and 53% of men) (Table 4). For example, among women, more women with private insurance (individual or employer-sponsored plans) (34%) than women with Medicaid (21%) say their plan did not cover medical care they thought was covered, or paid less than expected, in the past 12 months. Among women ages 18-49 who had a telehealth visit in the past two years, 2% say prenatal or postpartum care was the primary purpose for the most recent telehealth, including 2% of those ages 18-25, 4% of those ages 26-35, and 5% of those ages 36-49 (data not shown). Among women ages 18-25 who had a telehealth visit in the past two years, three in ten (29%) say the primary purpose for their most recent telehealth visit was mental health services, compared to just 10% of women ages 50-64. Among women ages 18-64 who had a telehealth visit in the past two years, nearly two in ten (18%) say the primary purpose for their visit was for an annual check-up or well-visit, minor illness or injury, or mental health services (Table 2). Women living in rural areas are less likely than those living in urban areas to have had a telehealth visit with a health care provider (49% vs. Nearly all women (95%) have seen a doctor or health care provider in the past two years (Figure 8). More women ages 50-64 (88%), White (84%) and Asian/Pacific Islander (83%) women, women with higher incomes (85%), and those with private health insurance (86%) rely on an office-based physician for their regular care than their counterparts (Table 1). Women who live in a [state](https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/) that expanded Medicaid are more likely to have a usual source of care than women in states that have not expanded Medicaid (83% vs. Even though more uninsured women (23%) rate their health as fair or poor than insured women (17%), a higher share of insured women (65%) (data not shown) report taking take a prescription medication than uninsured women (43%). A larger share of Black (22%) and Hispanic (20%) women report being in fair or poor health than White (16%) and Asian/Pacific Islander (13%) women.

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Image courtesy of "Livemint"

Are SIPs competing with traditional health insurance plans as well ... (Livemint)

When Mercedes announced that SIPs (systematic investment portfolios) were their competition, it rang a bell.

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