An unhealthy gap

HEALTH insurers demonising medical specialists on gap charges masks that the biggest out-of-pocket costs patients face are due to often hidden exclusions in their cover.

Peter Sumich's opinion piece ('Butler makes bogeyman of doctors to distract from Medicare failures', The Australian, 13/10/26), nails it.

The Medicare Benefits Schedule hasn't kept pace with costs for more than a decade. So it's not surprising doctor gap fees go up. But it's paltry compared to insurance gaps.

A staggering 72 per cent of hospital insurance policyholders have exclusions in their cover. It may seem counterintuitive but insurers price people out of the Gold cover and actively cold call members to suggest they downgrade cover.

This saves on claims costs. Patients are increasingly getting caught out paying for silver cover, only to pay bills in the tens of thousands when sick or injured.

In demonising doctors, the Albanese government ignores health insurers' rampant profiteering.

As Sumich states, they annually pocket more than $2 billion in record after-tax profits and $3.4 billion in so-called management expenses.

All from your premiums. They short-change private hospitals by more than $1 billion every year.

Sure, make doctors accountable. But don't be distracted from the real culprits.

Brett Heffernan, CEO, Australian Private Hospitals Association. Published in The Australian newspaper on 14 October 20206.

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15/7/2026 Insurers are the real healthcare culprits