Patients the punch line in April Fools' joke

WHOEVER decided health insurance premium hikes kick-in on April Fools' Day had a warped sense of humour. But when the federal government mandates the increase without any regard to insurance companies meeting their obligations, it reduces healthcare to a sick joke.

"The federal government has direct skin in the game," APHA CEO Brett Heffernan lamented. "You can't wave through the biggest annual premium hikes in a decade, especially at a time when insurers are banking record profits, only to abrogate all responsibility for where those funds end up.

"We know from four-years of bitter experience that health insurers are not honouring their part of the deal. It's families doing the right thing in paying their own way through healthcare, taking pressure off the public system, who are paying more only to get less from their insurers."

While 'official' premiums go up an average 4.41% from 1 April, in reality, the majority of the 12.6 million Aussies with private hospital cover will pay much more. Medibank, Bupa, NIB and HCF account for three-quarter of all insured people and their average premiums are going up by 5.1%, 4.8%, 5.47% and 4.96%, respectively. HCF's Gold level policy will rise by a whopping 25%.

"It's galling for everyone, especially families who are paying these increases at a time when health insurers are banking over $2 billion a year in record annual after-tax profits," Mr Heffernan added.

"Faced with these higher costs, there has been an exodus of people dumping Gold level cover. Some 15% have downgraded their cover since 2022. It may seem counter-intuitive, but pricing families out of Gold insurance is a strategic windfall for the insurers' business model.

"At the Silver and Bronze levels, people are still paying a motza but if they get sick or injured, their cover is riddled with, often hidden, exclusions. This sees insurers refuse to pay for many procedures and treatments. It's the number 1 complaint against health insurers in last week's Commonwealth Ombudsman's State of the Health Funds report.

"Today, an unprecedented 70% of people with private hospital cover face these exclusion tactics from their insurers. Typically, they don't know what they are or aren't covered for until it's too late and, as patients, are at their most vulnerable.

"At the other end of the spectrum, the private hospitals providing treatment and care aren't being paid in full by insurers. Under increasingly dodgy contracting provisions, over the last four years the annual shortfall in funding to hospitals from insurers is over $1 billion a year.

"Add up the premium hikes, the exclusions and short-changing of hospitals and it's not hard to see how the insurers are making those record profits.

"Many private hospitals have closed, while others have had to permanently cancel 80 services, notably maternity and mental health units, reducing the choice and access insured people expect from their annual premiums.

"Those in power have lost sight of the fact that private health insurance is just a means to an end. That end being choice and access to the best treatment and care in a timeframe of now. Instead, the federal government's approach has been to bolster insurer profits at the expense of value for insured people and a public-private hospital system plunged into disarray.

"With private hospitals accounting for 70% of all planned surgery, 1.6 million medical treatments each year, including the majority (54%) of chemotherapy, 61% of acute mental health care and 80% of hospital rehabilitation, ignoring this insurer-induced crisis puts the health needs of all Australians on a razor's edge."

-ENDS-

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