1 0 Contemporary Issues in Private Health Insurance An industry discussion
2 1 Today s speakers Andrew Matthews, Medibank First Impressions Indula Abeykoon, BUPA Customer Migration Bronwyn Hardy, Teachers Health Actuaries & Broader Health Cover Rob Paton Draft Principles for PHI Reform Nicholas Stolk The Profession in PHI
3 2 First impressions Andrew Matthews
4 1. Remember What s Important 2. Make a positive contribution 3. Healthy...A wicked problem? 4. Adventure.A complex network!
5 4 Customer migration Indula Abeykoon
6 Context : some aspects of new product design New product considerations Customer Marketplace Internal Monitor Experience -Customer migration actual vs expected - KPI s actual vs expected -Customer feedback - Frontline feedback Launch Product - Customer feedback (website, call centre, retail centres, brokers, social media) - Customer focus groups -Choice modelling etc. Product Design & Pricing - Competitor products -Industry trends PHIAC data -Regulatory constraints eg. Community Rating, Portability - Customer migration - Product hierarchy - KPI s profit/growth/ cust satisfaction. etc
7 Customer migration Opportunities Simplification of product offering Reducing number of closed products Moving members to more relevant products Risks New products vs tweaking existing Where there is no forced migration, customer self-selection becomes a risk New products with higher benefits and/or lower premiums will lead to margin erosion Expected risk profile vs. actual risk profile Existing policies Monitoring Regular monitoring e.g. monthly Understand where margin is coming from e.g. different customer segments New Product New to industry From other health funds Migrated policies New business cannibalisation?
8 Discussion points Lessons learned from the past experience. Possible guidelines on what ought to be measured. Capital strain considerations - e.g. margin erosion FCR inclusion. Is customer migration risk material?
9 8 Actuaries and Broader Health Cover Bronwyn Hardy
10 Actuaries and Broader Health Cover Broader Health Cover initiatives cover a wide variety of programs designed to: Improve health and wellbeing Reduce the impact of known diseases or conditions Offer alternatives to hospitalisation where appropriate The success of such programs has many facets Clinical efficacy Financial benefits Member wellbeing Actuarial involvement Targeting individuals for involvement Forecasting utilisation Program evaluation
11 10 Draft Principles for PHI Changes Rob Paton
12 Changes for the PHI System : Draft Principles Build from Actuaries Institute Health Financing Policy position. Assume no services/costs shift either to or from Medicare as part of changes to PHI. Maintain community rating structure i.e. guaranteed access and portability, no improper discrimination, risk equalisation consistent with tabular premium structure. Permit tabular premiums to vary by appropriate demographic characteristics (e.g. age, gender, state, scale, etc). Loading of tabular premium by insurer not permitted. Permit tabular premium discounting determined by insurer at individual policyholder level, based on objective evidence (including health status), subject to a substantial maximum discount. Model central estimate premiums based on discounting assumptions Permit each policyholder to establish a health savings account associated with an insurance policy to pay copayments, deductibles and premiums at policyholder option Require an appropriate minimum co-payment by the policyholder in respect of each material insured service delivered by a provider. Insurer would pay each provider only after policyholder certifies as to accuracy of each such material service
13 Changes for the PHI System : Draft Principles (continued) Permit (but not require) limited prefunding of insured benefits. Encourage insurer connection to policyholder s GP (e.g. premium discount). Encourage each provider and each policyholder to use the policyholder s e-health record to maximum extent available. PHIAC to publish system level fee data for each provider and to establish link to each provider licensing authority. Index (regularly) each numeric. Specify minimum policy benefits at low levels which include minimum preventative services. Consider increasing current maximum waiting periods. Benchmark PHI premiums covering minimum benefit policy for single persons below age 60 against an appropriate full-time earnings measure. Determine risks in specific proposals and appropriate mitigants. Progressively reduce premium rebates over time. Determine a gradual pathway for implementation.
14 13 The Profession in PHI Nick Stolk
15 14 Where do actuaries work in PHI? At the time of writing, there were 13 unique Appointed Actuaries three internal, ten external consultants. Institute members were employed on the staff of 13 health insurers (as per below), as well as, a number of consultancies and PHIAC.
16 15 The rise of products with exclusions and/or restrictions 100% 90% 80% 70% 60% 50% Percentage of policies with exclusions and/or restrictions Increasing attention is also given to product value. 40% 30% There are a range of consumer views on policy exclusions. Some people don t want to pay for things they don t need, others believe exclusions undermine their cover. 20% 10% 0% Sep-02 Mar-03 Sep-03 Mar-04 Sep-04 Mar-05 Sep-05 Mar-06 Sep-06 Mar-07 Sep-07 Mar-08 Exclusion/Restriction Insurer 1 Exclusion/Restriction Insurer 2 Exclusion/Restriction Insurer 3 Exclusion/Restriction Insurer 4 Exclusion/Restriction Insurer 5 Exclusion/Restriction Small insurers Exclusion/Restriction Australia Sep-08 Mar-09 Sep-09 Mar-10 Sep-10 Mar-11 Sep-11 Mar-12 Sep-12
17 16 A new entrant Health.com.au Pty Ltd commenced trading on 16 April They are the first new entrant to the PHI industry since 2006/07. Their CEO has stated that they would focus on providing a highly transparent product that solved people's health insurance needs. Health.com.au Pty Ltd utilizes iselect as its primary distribution channel. PHIAC made their registration as a health insurer subject to a number of conditions for their first three years of operation including: Monthly PHIAC 2 reporting; Actuarial sign-off on quarterly PHIAC 2 returns; and Not applying for a transfer of assets. 20,000 16,000 12,000 8,000 4,000 0 March 2012 Health.com.au Hospital SEUs June 2012 Hospital SEUs September 2012 December 2012 Approx hospital market share March % 0.20% 0.15% 0.10% 0.05% 0.00%
18 17 Aggregators A quick web survey reveals at least 11 comparison sites now featuring health insurance Brokers driving up costs SMH, 15 April 2013 This article represents a lot of the recent industry debate Medibank claims: Growth of comparison sites have led to higher premiums Industry-wide surge in advertising costs Haven t changed the dynamics of affordability iselect claims: Increases the size of the PHI market Helped match people to appropriate insurance Is explicit about commissions Funds wouldn t use us if we weren t an efficient form of distribution for their products. iselect, the largest of the aggregators in PHI, has been mooted for ASX listing for some time expected listing in 2013.
19 18 To discuss 1. Is health insurance an attractive area to young actuaries? Do we need to do more to attract actuaries to health insurance practice? 2. What and where are the main opportunities for actuaries working in PHI? What are the most significant threats? 3. Are there any areas where actuarial practice in PHI needs to evolve? 4. What do you think the Institute s Health Practice Committee should be focusing on now to ensure PHI actuaries remain sought after in the future?
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