AMA private health insurance report card 2016 points to HCF being best in class

Sydney, 18 March 2016 - Unfortunately HCF was not contacted by the AMA when the report card was being produced so does not feature. If included HCF would have been recognised ‘best in class’ (as the attached table shows), with:

  • 18 out of 22 (82%) common procedures researched by the AMA would have been shaded blue for having a high level of benefits,
  • as importantly, zero out of 22 would have been shaded red for having a low level of benefits.

These results confirm the findings for medical services with no gap reported by the Private Health Insurance Ombudsman in the annual State of the Health Fund Report. In the 2014 report¹, the latest available, HCF had the highest percentage of medical services with no gap in every single State and Territory:

Table 4A - Medical services with no gap fund or gap scheme

  ACT NSW VIC QLD SA WA TAS NT
BUPA 76.2% 84.0% 89.8% 85.5% 92.4% 81.1% 91.1% 78.6%
CDH 50.0% 89.8% 75.7% 67.2% 62.6% 50.0% 37.0% N/A
GMHBA 45.7% 69.2% 85.8% 70.8% 62.5% 62.7% 71.9%
47.3%
HBF 78.2% 60.2% 64.9% 64.3% 68.7% 83.8% 73.1%
73.2%
HCF 85.5% 94.4% 98.0% 96.5% 99.7% 95.7% 99.1% 95.3%
Latrobe 50.4% 74.5% 87.3% 77.8% 76.4% 53.0% 77.9% 72.6%
MDHF 53.2% 80.1% 82.5% 57.0% 70.9% 56.7% 85.4% 65.3%
Medibank 80.5% 90.4% 95.0% 92.3% 94.2% 82.7% 96.0% 84.5%
NIB 58.6% 84.7% 81.0% 76.0% 86.0% 70.8% 84.1% 75.1%
St Lukes 53.5% 80.5% 82.2% 69.9% 81.3% 75.6% 90.6% 8.3%
Access Gap Participants 77.9% 91.4% 94.9% 90.8% 95.1% 84.8% 91.8% 84.8%
Total / industry outcome 78.0% 89.1% 92.6% 89.2% 93.5% 83.4% 92.6% 82.1%

¹ http://www.ombudsman.gov.au/publications/state-of-the-health-funds-report - page 16

We look forward to working with the AMA in producing the 2017 report. More importantly we look forward to working with the AMA to address the challenge of out-of-pocket costs, in particular embracing the need for transparent information. As the AMA quite rightly points out different insurers pay different benefit amounts for the same medical service. But so too do different doctors charge different amounts for the same medical service. To use the example in the Report Card, for an uncomplicated delivery of a baby, one doctor charged $3,600 while another charged the MBS rate of $694 – a difference of more than 500 per cent.

50.0%
50.0%
71.9%
71.9%
85.5%
71.9%

AMA 2016 report card

554.2KB PDF

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