News Brief: English
Summary
The Australian Medical Association’s report warns that private health insurance is failing to deliver value, with rising premiums, reduced coverage, and significant payment variations. It calls for urgent reform, including mandating insurers return 90% of premiums as benefits and establishing an independent regulator.
Key Points
- Eroding Value: Premiums are rising faster than wages/inflation, while 70% of policies now have exclusions, narrowing coverage.
- Shifting Demand: Policy numbers increased, but demand for comprehensive Gold-tier policies fell as people opt for cheaper, less-covered options.
- Payment Disparities: Benefits for the same procedure (e.g., childbirth) can vary by nearly 30% between insurers and differ by location.
- Call for Reform: The AMA demands a law requiring insurers to pay at least 90% of premiums back as patient benefits and wants a new independent oversight authority.
- Industry Dispute: Insurers argue they are paying record amounts for care, and a 90% payout rule could bankrupt some funds and reduce competition.
- System Strain: An underfunded public system forces people into private care they may not afford. Private hospitals also face financial pressure from insurers.
新闻简报：中文
摘要
澳大利亚医学协会的报告警告，私人医疗保险的价值正在”被侵蚀”，保费上涨、承保范围缩小且支付金额差异巨大。报告呼吁紧急改革，包括强制保险公司将90%的保费以福利形式返还给消费者，并建立一个独立的监管机构。
关键点
- 价值侵蚀：保费增速超过工资和通胀，同时70%的保单现在包含免责条款，承保范围缩小。
- 需求变化：保单数量增加，但人们对综合性黄金级保单的需求大幅下降，转而选择更便宜、承保范围更小的选项。
- 支付差异：不同保险公司对同一手术（如分娩）的赔付额差异可高达近30%，且赔付额因地区而异。
- 改革呼吁：AMA要求立法强制保险公司将至少90%的保费作为治疗福利返还给患者，并希望设立新的独立监管机构。
- 行业争议：保险公司反驳称他们正支付创纪录的医疗费用，90%的赔付率可能导致部分基金破产并减少竞争。
- 系统压力：资金不足的公共系统迫使人们选择可能负担不起的私人医疗。私立医院也因保险公司的支付问题面临财务压力。
Original Article Link: https://www.abc.net.au/news/2025-12-05/private-health-insurance-eroding-as-doctors-urge-reform/106095198