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More choice in health insurance FROM 2007, private health funds will be able to offer broader health insurance.This means funds will be able to pay benefits for a wider range of services effectively removing the current boundary between "hospital" and "ancillary" insurance. The change is not expected to have an impact on the premiums people have to pay. These changes will be supported by allowing Outreach Hospital in the Home services to be covered by the broader health cover; the introduction of a uniform quality and safety regime for all privately insured services; and new risk equalisation arrangements. As a result, the needs of Australians will be better met - and private health insurance cover will be able to reflect current clinical practice. How the new choices will affect people Broader health insurance means that health funds will for the first time, be able to design and offer products for a: * person with a chronic disease, such as diabetes that covers specific programs aimed at assisting them manage their own health needs; * person with cancer that will enable them to have chemotherapy in or out of hospital and still be covered by their private health insurance. The introduction of broader health cover should allow the best care to be provided in the most suitable location for the member. So that people can be confident that these services are provided by qualified providers, there will be an increased focus on ensuring high quality and safety requirements for all privately insured services. This will involve the Department working with the private health industry and the Australian Commission on Safety and Quality in Health Care to develop safety and quality standards so that privately insured services are provided by suitably qualified providers in accredited facilities. What has been restricting health insurance choices? Currently, private health care must be performed in-hospital if members are to receive a benefit from their health fund hospital tables with ancillary insurance only able to covers other kinds of health services. As a result, many patients seek in-hospital treatment in order to use their private health insurance when safe and suitable out-of-hospital services may exist at less cost for that particular treatment. Health funds have been prevented from covering preventive treatments and services that are provided as a substitute for in-hospital care. Currently these need to be approved by the Australian Government. The Government's changes will mean health funds will be free to design and sell products that offer people greater choice so that they may be able to purchase cover that better suits their individual health needs. Insuring for self-management of health care The changes mean that health funds will be able to offer products that provide payment of benefits for services which do not require admission to hospital. Insurance programs that encourage members to manage their own health care, and therefore prevent hospitalisation, will also be able to be covered. When the changes will be made From April 2007, health funds will be able to offer products that pay benefits for services that are part of, prevent, or substitute for hospital services. This will remove the current boundary that exists between "hospital" and "ancillary" insurance. From April 2007, Outreach Hospital in the Home services will be able to be included in a broader health cover product without needing to be approved by the Government. From July 2008, only suitably qualified and accredited health service providers will be able to offer privately insured services. This will give people confidence in the safety and quality of the services being covered by their health insurance. From April 2007, new risk equalisation arrangements that support community rating under broader health cover will be introduced. Under these arrangements, single parent families will no longer be treated in the same way as a couple with dependents. Health funds will continue to be prevented from covering out-of-hospital services offered by GPs. |
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