In-hospital intravitreal injections are ‘low-value’ procedures: health fund

Intravitreal injections provided in private hospitals are relatively ‘low-value’ procedures that can be safely carried out in ophthalmologists’ rooms at much lower cost,                                                           according to private health fund, HCF.

An analysis of HCF claims data for 21 procedures puts intravitreal injections in private hospitals at the top of the list

At the top of the list is inpatient intravitreal injections – a shot of medicine into the eye to protect  vision – which experts say is a good procedure but shouldn’t be performed in hospitals because it only adds “enormous cost for no clinical benefit”.

They said almost all of the 5699 admissions for inpatient intravitreal injections were “low value”.

“Overall, 17 per cent of the injections are happening in the inpatient setting in the private system and that’s growing at 25 per cent a year,” co-author Professor Adam Elshaug said.

By | September 7th, 2018|Health insurance|

Opposition back-flips on health-insurance caps

Federal Labor’s opposition leader, Mr Bill Shorten, has back-flipped to favour small health funds over his previous commitment to impose caps on all health-insurance premiums.

Mr Shorten previously announced plans to impose a two-per-cent cap on health insurance premium increases, however he is now is understood to have told the Members Health Fund Alliance – which represents 23 small funds that cover 1.7 million Australians – that its members would not be affected by the proposed cap.

Labor has indicated the cap is aimed more at larger health-insurance providers, and that imposing it on smaller providers would lead to more consolidation in the sector.

Critics say it is an example of Mr Shorten’s indecisiveness, including his being forced to carve out pensioners from his dividend imputation crackdown and abandoning his plan to repeal already-legislated tax cuts for businesses with a turnover of up to $50 million.

In an email marked “strictly confidential” and “not for circulation”, the chief executive of the Members Health Fund Alliance, Mr Matthew Koce, detailed a private meeting with Mr Shorten at Parliament House in Canberra in June where he received assurances that smaller funds would not be affected by the shake-up.

By | July 19th, 2018|Health insurance|

Health-premiums cap would leave insurers on brink of insolvency

A proposal by the federal opposition for a 2-per-cent cap on health insurance premium increases in the event of it winning office would lead to eight insurers operating at a loss in the first year and put three on the brink of insolvency in the second year, according to an industry analysis.

The biggest health policy from Bill Shorten to date — capping premium increases at roughly half the current rate for two years to allow for another inquiry — would also put the more dominant health funds at a competitive ­advantage.

The Australian newspaper also reports slashing premium revenue would likely prompt insurers to reduce benefits and payments, undermining several years of reforms before a Labor government would even be in a position to ­respond to an inquiry by the Productivity Commission.

Industry body Private Healthcare Australia commissioned an analysis of data on the sector and the potential impact of the proposed cap. The analysis suggests eight insurers would be in deficit at their current level of expenditure growth in year one of such a cap. In year two, 15 funds would be in deficit — three on the brink of insolvency if hit with growth in costs or claims.

By | July 1st, 2018|Health insurance|

250,000 didn’t renew health insurance in past 12 months; 53% say too expensive

More than 250,000 people did not renew their private health insurance during the 12 months to March this year, according to the latest annual Roy Morgan survey involving 50,000 face-to-face interviews with consumers, including 20,000 private-health-insurance-fund members.

The 256,000 finding was up on last year’s 182,000, making it the highest level of cancellations in five years.

Being “too expensive” is the main reason that consumers give for dropping out of health insurance, which has risen to 53.3% over the year, up from 47.1% in the previous year.

The second major concern among those who didn’t renew is to do with the gap in coverage by their fund. In the current year there was a big increase in the proportion saying that their major reason for leaving was “too much out-of-pocket expense” with 19.1%, up from 12.8% last year.

Nearly one in six (15.5%) of members who didn’t renew said “Medicare suits my needs”, up from only 5.3% last year. It appears that there are an increasing number of people seeing no real value in having private health insurance, given its cost and perceived benefits over simply relying on Medicare.
Over the year there was also an increase in concerns regarding service, with 11.6% saying that they didn’t renew because of “poor service’”, up from 2.3%

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By | May 20th, 2018|Health insurance|

Medicare levy rise to be scrapped

Plans for a 0.5-per-cent rise in the Medicare levy from next year towards filling the $8 billion expected $57-million funding shortfall for the National Disability Insurance Scheme will not proceed.

The decision will mean savings ranging from $250 extra tax a year for persons on an income of $50,000 to $1,500 for those on an income of $300,000.

The $8-billion levy has been scrapped by the federal government on the ground that tax receipts are higher than expected and that there is no need for it.

By | April 29th, 2018|Health insurance|

Health-fund premiums rise by average of 3.95%

Premiums for cover by private health insurance companies rose by an average of 3.95 per cent on 1 April, with Bupa rising by the highest percentage – 3.99 per cent.

Medibank Private rose by 3.88 per cent, NIB 3.93, HCF 3.39, and HBF 3.75.

The proportion of Australians with hospital cover fell to 45.6 per cent in the December quarter amid concerns over high premiums, confusing policies and unexpected out-of-pocket expenses.

By | April 18th, 2018|Health insurance|

Major health fund to limit gap cover to contracted sites; cancels low-premium cover for ‘costly’ operations

Australia’s biggest private health insurance group, Bupa, has announced two new policies within a week that will drastically change the health insurance system.

The fund has told more than one third of its members who have lower-premium cover that they will no longer be able to claim benefits to cover the ‘gap’ for costly operations, meaning they will have to either take out more-expensive cover or run the risk of not needing one of what the fund has declared to be costly operations.

It has also advised members it will limit gap cover to its contracted sites (hospitals).

To date, there has been no response from other private health funds, but they may well follow Bupa’s lead before long.

By | March 4th, 2018|Health insurance|

Private health insurers want to reduce benefits for intravitreal injections

Private health insurers want to reduce benefits payable for intravitreal injections to treat aged macular degeneration in hospital clinics rather than in ophthalmologists’ rooms.

The funds are complaining about the $44 million annual cost of intravitreal injections delivered in a hospital setting – about 10 per cent of procedures.

Not surprisingly, health funds want to reduce benefits payable for the procedures but because they are delivered in-hospital, they are obliged to pay ophthalmologists nearly $800 more per treatment than what is paid by patients being treated in ophthalmologists’ rooms.

In most instances, it is likely patients may not be aware of the extra charge because they are not ‘admitted’ to a hospital, but treated in a clinic within one.

The Royal Australian and New Zealand College of Ophhalmologists’ policy is that intravitreal injections may be safely performed in ophthalmologists’ rooms as well as in hospital clinics.

To illustrate the basis for their concern, Medibank Private told The Australian newspaper that 12,500 patients had the procedure performed in hospital in the 2016 financial year, while Bupa said it had seen a 78-per-cent increase in the procedure performed in hospital between 2014 and 2017.

By | February 25th, 2018|Health insurance|

Health-insurance premiums set to rise 4%

Private health-insurance premiums are set to rise by an average of 4 per cent on 1 April, judging from comments made yesterday by the federal health minister, Mr Greg Hunt.

Such an increase would be the lowest in percentage terms since 2001, but would still be nearly twice the rate of general inflation and would add about $200 a year to the average policy.

Above-inflation premium increases

It means that the government’s much vaunted sweeping changes and cuts to the medical devices sector, which is usually blamed for above-inflation premium increases, have so far (since October) only delivered a 1-per-cent reduction in premiums compared with 2017, which had an average 5 per cent rise.

Mr Hunt last year said the government wanted this year’s increases yto be “as close as possible” to the inflation rate of 2 per cent.

Opposition health spokeswoman Catherine King said the premium rise was more disappointing news for people struggling with cost-of-living pressures and stagnant wages.

“The government will now have presided over a 25-per-cent increase in private health insurance premiums [since it won office in 2013].

By | January 21st, 2018|Health insurance|

Major reforms to make private health insurance simpler and more affordable

The federal government has announced a wide-ranging package of reforms to make private health insurance simpler and more affordable for Australians.

The reforms include:

  • Encouraging younger Australians to take up private health insurance by allowing insurers to discount hospital insurance premiums for 18 to 29 year olds by up to 10 per cent. The discount will phase out after people turn 40.
  • People with hospital insurance that does not offer full cover for mental health treatment will be able to upgrade their cover and access mental health services without a waiting period on a once-off basis.
  • To support Australians in regional and rural areas, insurers will be able to offer travel and accommodation benefits for people in regional and rural areas that need to travel for treatment.

The government has entered into an agreement with the Medical Technology Association of Australia to lower the price of implanted medical devices from 1 February next year, which will have immediate benefits for consumers in the form of lower premiums from April.

Maximum excess can be increased

The maximum excess consumers can choose under their health insurance policies will be increased for the first time since 2001, which will allow many consumers to reduce their premium increase in 2019.

Private health insurance will be simplified by requiring insurers

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By | October 16th, 2017|Business, Health insurance|