We expect Health Insurers to play an integral role in the future development of the Australian health system’s models of funding and service delivery.
The Australian health insurance industry now provides private hospital coverage to nearly one in two Australians, following sweeping reforms in recent years. These reforms aimed to arrest the following destructive spiral:
This spiral led to the level of population covered falling to nearly 30%, with an unacceptably high average contribution. The government’s suite of reforms included a 30% premium rebate and the introduction of lifetime health cover.
Other less high-profile reforms have included:
- A proposal to introduce a reinsurance system based on risk rather than expenditure
- An improved product profile to provide “no gap coverage” for private hospital episodes
- An encouragement for funds to enter into “contracts” with service providers so as to improve the risk sharing and health outcomes of members, and
- An extension of hospital benefits to include “hospital in the home” and certain aspects of co-ordinated care.
We expect these reforms to lead to health insurers becoming far less like “banks”, as they have largely operated in the past, and more like true health managers with the interests of their members at the forefront.
However this environment also introduces an extremely competitive focus in product design, pricing and service delivery which will demand high quality modelling, analysis and monitoring.
PricewaterhouseCoopers Actuarial has over two dozen specialists in Health Casualty working on risk analysis and modelling in Health Insurance.
Key specialist: John Walsh
 | Relevant experience:
- Specialist in accident compensation and health insurance
- Has been involved in the health and disability industry for nearly 20 years
- Has advised government in the areas of long-term care, health funding and information requirements in the health industry
- Particular expertise in the notion of risk-based funding and allocation of resources
- Clients include the Department of Health and Aged Care, NSW Department of Health, Medical Benefits Fund, NSW Motor Accidents Authority, SA WorkCover Corporation and the Insurance Council of Australia.
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