Australia's peak medical group has released its latest annual scorecard on private health insurance and warned the country's private health system is on a "precipice".
Australia's peak medical group has released its latest annual scorecard on private health insurance and warned the country's private health system is on a "precipice".
Australian Medical Association president Dr Tony Bartone said an increasing number of young Australians were abandoning private health insurance.
At the same time, a higher proportion of older patients were becoming more expensive to insure and were driving up premiums.
"This trend is not sustainable," Dr Bartone has warned.
"Sooner or later the number of people with private health insurance will fall further - and dramatically."
The 2019 scorecard reveals the top performing funds when it came to coverage in each state and territory, with the best policy dependent on where punters lived.
Depending on the state or territory, open membership insurers - accessible for any person - only covered around 25 per cent of hospital-related charges like beds and nurse care.
In some states or territories, open membership insurers only covered around 26 per cent of medical services with no gap (out-of-pocket) costs.
The scorecard also lists the highest and lowest benefits paid for medical services, with consumers potentially able to be covered by an additional $350 for a typical knee replacement depending on their insurer.
But these costs also relied on where policyholders lived, with Bupa customers in Victoria covered for nearly $350 more for a hip replacement than customers in NSW, ACT, WA, Queensland and the Top End.
The scorecard also pointed out how the number of policies excluding particular conditions now outnumber the number of non-exclusionary policies.
The number one complaint people had with their private health insurance policies is on benefits, in terms of non-payment or delayed payment, as well as out of pocket costs.
The AMA said customers should always get everything in writing, with incorrect or unhelpful advice provided verbally often leading to people misunderstanding what they were covered for.
The federal government introduced new reforms that came into effect in April requiring insurers to tier their policies from Basic, Bronze, Silver to Gold.
While Dr Bartone welcomed the new categories, he said the government's review did not address affordability or value for money.
There had also been a steady increase in premiums averaging three to five per cent per year as wage growth remained stuck at around two per cent.
"We need to work to bring back the value in insurance policies, before it is too late," he said.
Health department bureaucrats told a Senate estimates committee last week that the 3.25 per cent increase in premiums in April was the lowest average increase in 19 years.
But at the same time, department staffers admitted premiums were at a record high.
The 2019 Australian Medical Association scorecard reveals the top performing private health funds when it came to coverage in each state and territory.
PRIVATE HEALTH FUNDS COMPARED
Best and worst open member private health insurers per jurisdiction for percentage of hospital-related charges covered
* ACT
Best: HCI with 96.7 per cent of charges covered
Worst: CDH with 25.5 per cent of charges covered
* NSW
Best: CDH with 96.4 per cent of charges covered
Worst: GMHBA with 80.7 per cent of charges covered
* Victoria
Best: Westfund with 96.3 per cent of charges covered
Worst: health.com.au with 83.9 per cent of charges covered
* Queensland
Best: CBHS Corporate with 95.2 per cent of charges covered
Worst: CDH with 78.2 per cent of charges covered
* South Australia
Best: Phoenix with 97.8 per cent of charges covered
Worst: CBHS Corporate with 80.5 per cent of charges covered
* Western Australia
Best: CBHS Corporate with 96.6 per cent of charges covered
Worst: CDH with 71.7 per cent of charges covered
* Tasmania
Best: CDH with 99.2 per cent of charges covered
Worst: GMHBA with 88 per cent of charges covered
* Northern Territory
Best: HCI with 100 per cent of charges covered
Worst: St Lukes with 48.5 per cent of charges covered
Best and worst open member private health insurers per jurisdiction for percentage of medical services covered with no gap (out-of-pocket costs) covered
* ACT
Best: CBHS Corporate with 85.7 per cent of medical services covered with no gap
Worst: MDHF with 28.6 per cent of medical services covered with no gap
* NSW
Best: QCH with 93.2 per cent of medical services covered with no gap
Worst: HBF with 43.1 per cent of medical services covered with no gap
* Victoria
Best: Westfund with 93 per cent of medical services covered with no gap
Worst: CBHS Corporate with 34.6 per cent of medical services covered with no gap
* Queensland
Best: CBHS Corporate with 96 per cent of medical services covered with no gap
Worst: HBF with 36.4 per cent of medical services covered with no gap
* South Australia
Best: Transport Health with 94.5 per cent of medical services covered with no gap
Worst: HBF with 36 per cent per cent of medical services covered with no gap
* Western Australia
Best: Transport Health with 90.6 per cent of medical services covered with no gap
Worst: CDH with 59.1 per cent of medical services covered with no gap
* Tasmania
Best: health.com.au with 98.1 per cent of medical services covered with no gap
Worst: HBF with 38.9 per cent of medical services covered with no gap
* Northern Territory
Best: HCI with 100 per cent of medical services covered with no gap
Worst: HBF with 26.2 per cent of medical services covered with no gap
(Sourced: Australian Medical Association)
