Private Health Ministerial Advisory Committee

This page contains information on the Private Health Ministerial Advisory Committee.

Page last updated: 16 April 2018

On 8 September 2016 the Private Health Ministerial Advisory Committee was established to examine all aspects of private health insurance and provide government with advice on reforms including:

  • developing easy-to-understand categories of health insurance
  • developing standard definitions for medical procedures across all insurers for greater transparency and simplifying billing
  • ensuring private health insurance meets the specific needs of Australians living in rural and remote Australia.
Media release "New Committee to provide recommendations on private health insurance reform"

The committee met for the first time on 29 September 2016. The outcomes, including discussion and next steps, from each meeting will be published here under the Meeting Summary link below.

Committee membership

Chair

Dr Jeffrey Harmer AO has been selected to chair the Private Health Ministerial Advisory Committee.

Committee members

Committee members have been selected from the following organisations:
  • Consumers Health Forum - Mr Tony Lawson
  • COTA - Mr Ian Yates AM
  • Private Healthcare Australia - Dr Rachel David
  • Members Health Fund Alliance - Mr Matthew Koce
  • Australian Private Hospitals Association - Mr Michael Roff
  • Catholic Health Australia - Mr Toby Hall
  • Day Hospitals Australia - Ms Jane Griffiths
  • Australian Medical Association - Ms Anne Trimmer
  • Royal Australasian College of Surgeons - Mr Philip Truskett AM
  • Allied Health Professions Australia - Mr Marcus Dripps
  • Medical Technology Association of Australia - Mr Ian Burgess
  • Independent expert - Mr Garry Richardson.

Committee – Terms of Reference

The Terms of Reference guide the work of the Committee.

Committee – work plan

The Committee has agreed to the committee work plan. This will form the basis of Committee and working group considerations through to late 2017.

Committee – Meeting Summaries

  1. Meeting Number 1 – 29 September 2016
  2. Meeting Number 2 – 9 November 2016
  3. Meeting Number 3 – 7 December 2016
  4. Meeting Number 4 – 1 February 2017
  5. Meeting Number 5 – 22 February 2017
  6. Meeting Number 6 – 15 March 2017
  7. Meeting Number 7 – 4 April 2017
  8. Meeting Number 8 – 10 May 2017
  9. Meeting Number 9 – 14 June 2017
  10. Meeting Number 10 – 7 September 2017
  11. Meeting Number 11 - 8 November 2017
  12. Meeting Number 12 - 13 February 2018

Improved Models of Care Working Group

The Committee has established a working group whose members have expertise in the private health insurer, consumer and clinical practice environment to work in partnership on options to improve the delivery of privately funded mental health and rehabilitation services. The working group held its first meeting on 20 March 2018.

The Improved Models of Care Working Group Terms of Reference guide the group’s work and have been approved by the Committee.

A meeting summary will be published following each meeting of the working group.
1. Summary of Meeting 1 of the Improved Models of Care Working Group 20 March 2018

Improving the value of private health for rural and remote consumers workshop – Summary

The Committee agreed a workshop be held with a range of stakeholder groups to discuss opportunities for improving the value of private health for rural and remote consumers. The workshop was held on 12 December 2016.

The Summary of workshop on improving the value of private health for rural and remote consumers contains the meeting outcomes.

Contracting and Default Benefits Working Group

The Committee established a working group whose members have expertise in the private health insurer/hospital contracting environment to work in partnership on the development of possible reforms to contracting and private health insurance default benefit arrangements. The working group held its first meeting on 2 February 2017.

The Contracting and Default Benefits Working Group Terms of Reference guide the group’s work and have been approved by the Committee.

A meeting summary will be published following each meeting of the working group.

1. Contracting and Default Benefits Working Group Meeting Number 1 – 2 February 2017
2. Contracting and Default Benefits Working Group Meeting Number 2 – 9 February 2017
3. Contracting and Default Benefits Working Group Meeting Number 3 – 21 February 2017
4. Contracting and Default Benefits Working Group Meeting Number 4 – 3 March 2017

Information Provision for Consumers Working Group

The Committee has established a working group whose members have expertise in the private health insurer/information provision environment to work in partnership on the development of possible reforms relating to what information is provided to consumers and how that information is delivered. The working group held its first meeting on 28 February 2017.

The Information Provision for Consumers Working Group Terms of Reference guide the group’s work and have been approved by the Committee.

A meeting summary will be published following each meeting of the working group.

1. Summary of Meeting 1 of the Information Provision Working Group
2. Summary of Meeting 2 of the Information Provision Working Group
3. Summary of Meeting 3 of the Information Provision Working Group

Clinical Definitions Working Group

The Committee has established a working group whose members have expertise in the private health insurer/clinical practice environment to work in partnership on the development of possible reforms to standardise clinical definitions used in the information that insurers provide about their products.

The Clinical Definitions Working Group Terms of Reference guide the group’s work and have been approved by the Committee.

A meeting summary will be published following each meeting of the working group.

1. Summary of Meeting 1 of the Clinical Definitions Working Group 22 March 2017
2. Summary of Meeting 2 of the Clinical Definitions Working Group 19 April 2017

Risk Equalisation Working Group

The Committee has established a working group whose members have expertise in the private health insurance risk equalisation arrangements to work in partnership on the development of possible reforms to risk equalisation. The working group held its first meeting on 5 October 2017.

The Risk Equalisation Working Group Terms of Reference guide the group’s work and have been approved by the Committee.

A meeting summary will be published following each meeting of the working group.
  1. Summary of Meeting 1 of the Risk Equalisation Working Group 5 October 2017
  2. Summary of Meeting 2 of the Risk Equalisation Working Group 16 October 2017
  3. Summary of Meeting 3 of the Risk Equalisation Working Group 6 November 2017
  4. Summary of Meeting 4 of the Risk Equalisation Working Group 11 December 2017
Please direct any enquiries to PHMAC Secretariat

Product design information

The Department of Health commissioned research and analysis to support the Committee’s consideration of product design reforms. The main focus of the research and analysis was to consider potential consumer responses and premium impacts which might result from the possible introduction of Gold, Silver and Bronze product categories.

Actuarial analysis highlighted that premiums for entry-level products would increase if restrictions were abolished and additional services were added to the minimum product standard. This premium increase would be expected to lead to reductions in membership levels.
PDF version: Private health insurance reform actuarial analysis (PDF 5017 KB)

Consumer research was undertaken to determine the likely consumer responses to the possible introduction of a new Bronze product category covering additional services.
PDF version: Consumer research presentation (PDF 1088 KB)

Following consideration of the findings of the research and analysis, along with other stakeholder communication and policy advice, the Government decided not to make changes that would increase premiums for entry-level products. A factsheet has been prepared outlining the role of entry-level products in the private health insurance market.
PDF version: Low Priced Products Factsheet (PDF 42 KB)
Word version: Low Priced Products Factsheet (Word 257 KB)

Following the Government’s announcement of the reform package, the Committee considered a product design issues paper at the 8 November 2017 meeting. The issues paper contains the key design principles for the implementation of Gold, Silver, Bronze, Basic product categories. The issues paper also includes draft minimum product standards for hospital products and general treatment products, and draft standard clinical definitions, which are being used for consultation with industry. The Government is continuing to consult through the Private Health Ministerial Advisory Committee on details of the new arrangements, which will take effect from 1 April 2019.
PDF version: Gold Silver Bronze Basic implementation Issues Paper(PDF 295 KB)
Word version: Gold Silver Bronze Basic implementation Issues Paper(Word 157 KB)

Prostheses information

The Independent Hospital Pricing Authority has provided the Minister for Health with the Report under s208 on prosthesis costs in public and private hospitals.
PDF version: Report under s208 on prosthesis costs in public and private hospitals (PDF 248 KB)
If you are having difficulty accessing the PDF, please contact: PHMAC Secretariat for an alternate version to be sent to you.

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