A Consumer View of Private Health Insurance

1
A Consumer View of Private Health Insurance

• Presentation to AHIA National Conference
• Wednesday, 1st November, 2006
• Samantha Gavel, Acting Ombudsman

2
Overview

• Level of consumer complaint to PHIO not high
• A number of reasons for this
• Consumers very unhappy when expectations not met
• Complex area for consumers
• Need for simple, accessible information.

3
893
710
Total 2570
967
4
PHIO Complaints
5
2006 PHI Reforms

• Government announced a number of changes to
  private health insurance regulation on 26th April
  2006
• Measures to provide better information to
  consumers
• - standard product information
• - consumer information website
• - further encouragement of IFC

6
Consumer Website

• Aim to improve quality/accessibility of info for
  consumers about private health insurance
• General information on private health insurance
• Comparative information on full range of health
  insurance products available to consumers (some
  2,000 products)
• Website will be operational on 1 April 2007.

7
Website Features and Content

• Healthcover search
• - Key features of current product
• - Search for new product or compare
• products.
• Check membership eligibility for restricted
  funds
• General fund and phi information
• Agreement hospital and gap doctor search
• Lifetime Health Cover calculator.

8
Implementation of Website

• Human Solutions selected by competitive tender
• Selection process focussed on consumer and fund
  usability
• PHIO Project Manager Kylie Palmer appointed
• Stakeholder liaison and consultation underway.

9
Industry Concerns

• Focus on price will lead to consumers taking
  cheaper, restricted products
• This will lead to higher complaint levels and
  dissatisfaction
• Product Comparison
• Number and range of products to be included.

10
Other Recent Developments

• Expansion of Ombudsmans jurisdiction to deal
  with complaints by and about wider range of
  providers and professionals
• Introduction of compulsory mediation where
  directed by the PHIO
• New object provision makes it clear focus of PHIO
  activities is on consumer protection.
• Industry Code of Conduct provides new protections
  for consumers.

11
Portability

• Complaints about inter-fund transfers have
  declined in 2005/06
• Transition Communication Protocols agreed by
  industry and endorsed by Ombudsman
• Mediation power available to Ombudsman from 1
  July 2006 in relation to HPPAs.

12
Informed Financial Consent

• No patient should be rendered an account, for
  any amount, that they had not knowingly approved
  following full financial disclosure prior to
  their admission to hospital.
• Report by Ombudsman October 2002

13
IFC and Doctors

• 137 complaints about medical gaps in 2004/05.
• Doctors need to tell the patient what their out
  of pocket gap will be.
• IFC exceptions and difficulties.

14
Private Patient Election

• Public Hospitals
• AHCAs specify public hospital election
  requirements
• National Standards released in 2001
• PHIO can check whether patient made a valid
  election.
• Some complaints from hospitals and funds.