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Private health insurance rebate: “the worst health funding policy in Australia’s history”

In voting down the Government’s efforts to reform the private health insurance rebate, the Opposition has revealed its poor grasp of health financing issues.

So says health policy analyst Jennifer Doggett, who describes the rebate as “a textbook example of the worst health funding policy in Australia’s history“.

She writes:

“Imagine if car insurance provided rebates for fuel expenses and the Government subsidised the cost of that insurance.  What would result from this (thankfully) hypothetical situation?  People would use more petrol than they do currently (since they don’t incur its full cost), petrol would become more expensive (due to the increased cost of administering the scheme as well as the blunting effect of subsidies on price signals); and richer people, who have bigger cars (on average) and more money to purchase fuel, would benefit disproportionately from the subsidy than those on low incomes.

It’s an absurd proposition but it’s exactly what happens in relation to health care funded by private health insurance.  Nicola Roxon’s attempt last night to reduce the rebate subsidies for high income earners with private health insurance is one small step towards minimising the adverse impact of this costly policy on the public purse.  The fact that it was defeated in the Senate demonstrates how little understanding the Opposition has of health funding issues.

Private health insurance is one of the most inefficient and expensive mechanisms for paying for health care.  Private health insurance funds spend about 13% of revenue on administration, compared with the 3% spent by Medicare.  Partly this is due to the economies of scale of Medicare but also because private funds have to spend money on advertising to compete against each other.  Higher administration costs drive up premiums which ultimately come out of the pockets of consumers and tax payers.

Private health insurance is inefficient in other ways.  By shifting demand from public to private services, doctors and nurses are attracted away from the public sector.  We have a fixed number of doctors and nurses in Australia.  When demand increases in the private hospital sector, health professionals will move there away from public hospitals.  With widespread health workforce shortages, we should be ensuring that the first priority for health professionals is to care for the sickest people in the community. Generally these are found in the public system.

Private health insurance does not make it easier for the most disadvantaged people to afford the health care they need.  The group with the poorest health status in the community, Indigenous Australians, has the lowest level of private health fund membership.  People on low incomes often can’t afford the high gap payments that come with private care, even if they can afford the monthly premiums.  And people with chronic conditions often find that the annual limits and caps on rebates for treatments run out long before they have received the treatment they require.

In fact, in most cases private health insurance is not really insurance.  Fixed rebates combined with open ended co-payments, such as those required for ancillary services by most forms of private health insurance, do not limit the risk of consumers incurring high health care costs.  Rather they act as an inefficient and overly complex budgeting measure to assist consumers with managing health care expenses.

Given the high costs and other disadvantages of an insurance model for funding health care, it should be used minimally. In sharing the risk of very unusual and high cost health care needs, the advantages of an insurance model probably outweigh its risks.  However, given that (by definition) the majority of health consumers do not experience unusual and unpredictable high health care costs, private health insurance should not be supported or subsidised by government as a mechanism for funding predictable and regular forms of health care.

Instead of blocking the Government’s laudable (although not nearly comprehensive enough) attempt to reduce the inefficient subsidy for high income earners, the Opposition should be focussing on finding more efficient ways of funding health care. There are a number of options for this (some outlined in the National Health and Hospitals Reform Commission Report), almost any of which would be an improvement on the current private health insurance model.

The private health insurance rebate was a terrible Howard-era policy, designed to buy off pensioners scared about the introduction of the GST before the 1998 election. It’s served its purpose. It’s cost us (the tax payer) billions. It’s prevented the development of other innovative and efficient funding mechanisms which genuinely respond to consumer needs.

It’s time it was pensioned off and allowed to live out its days as a textbook example of the worst health funding policy in Australia’s history.”

Comments 9

  1. Andrew Lewis says:

    Not quite sure how the Coalition justifies knocking back increases in alcopops tax and the health care rebate and in the same breath goes after the govt for too much spending.

    The health care rebate is a policy disgrace, and there is a lot of good money going to it. It’s a no-brainer to cut into it for higher income earners.

    Just one of many low hanging fruit in the good public policy garden.

  2. john2066 says:

    Well said Jennifer. Its also really amusing that the Howard government introduced the medicare surcharge for people over an income threshold who didn’t buy health insurance. In other words, “hey here’s a free market product we want people to chose and if you dont buy it we’ll force you with a penalty tax!.” Just love free market approaches to health care.

    Private health insurance is a useless product we are forced to buy so greedy specialists and fund chiefs can drive new BMWs. The sooner its taken out the back paddock and shot the better.

  3. cecilgrass says:

    It really is a bit of a wild situation to put it mildly. When I needed life cover, it was so much simpler to go to http://www.life.realinsurance.com.au/Life-Insurance/Family-Life-Cover.aspx and get it than to find health insurance.

  4. frankie dean says:

    Much has changed regarding Health Fund Rebates over the past few years and at the same time Insurance Premiums are sky rocketing the Insurers are gradually reducing benefits paid in particular Ancillaries such as Optical.
    Privatehealth.gov.au has a cool short video that clearly states that the website exists to “help you maximise your Private Health Fund benefits whilst reducing your expenses”. Frankie Dean is a strong advocate of this statement, and you can find on the website a step by step guide as to how you can maximise your Optical Health Fund Benefits and minimise your out of pocket expenses when purchasing Optical / Prescription Glasses.
    http://www.frankiedean.com.au/private-health-insurance-in-australia
    And if you are one of the many Australians presently choosing not to renew your Extras Cover on your Health Fund Policy then it’s even more important to look to sites such as Frankie Dean that can help you save time and money.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017