Value and affordability of private health insurance and out-of-pocket medical costs

On 29 March 2017, the Senate agreed that on 1 June 2017 it would refer the following matter to the Senate Community Affairs References Committee for inquiry and report:

The value and affordability of private health insurance and out-of-pocket medical costs.

The terms of reference are:

  1. private and public hospital costs and the interaction between the private and public hospital systems including private patients in public hospitals and any impact on waiting lists;
  2. the effect of co-payments and medical gaps on financial and health outcomes;
  3. private health insurance product design including product exclusions and benefit levels, including rebate consistency and public disclosure requirements;
  4. the use and sharing of membership and related health data;
  5. the take-up rates of private health insurance, including as they relate to the Medicare levy surcharge and Lifetime Health Cover loading;
  6. the relevance and consistency of standards, including those relating to informed financial consent for medical practitioners, private health insurance providers and private hospitals;
  7. medical services delivery methods, including health care in homes and other models;
  8. the role and function of:
    1. medical pricing schedules, including the Medicare Benefits Schedule, the Australian Medical Association fee schedule and private health insurers’ fee schedules,
    2. the Australian Prudential Regulation Authority (APRA) in regulating private health insurers, and
    3. the Department of Health and the Private Health Insurance Ombudsman in regulating private health insurers and private hospital operators;
  9. the current government incentives for private health;
  10. the operation of relevant legislative and regulatory instruments; and
  11. any other related matter. 

Submissions were sought by 28 July 2017. The reporting date is 27 November 2017. On 16 November 2017, the Senate granted an extension of time for reporting until 15 December 2017. On 15 December 2017 the committee tabled an interim report proposing a further extension to 18 December 2017. On 18 December 2017 the committee tabled a second interim report proposing a further extension to 19 December 2017.

Committee Secretariat contact:

Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600

Phone: +61 2 6277 3515