Contemporary Issues in Private Health Insurance. Andrew Gale Ben Ooi David Watson

Transcription

1 Contemporary Issues in Private Health Insurance Andrew Gale Ben Ooi David Watson 1

2 Membership trends, financial results & price increases Reports & inquiries into health financing and costs Cost pressures on health and health insurance Political influences PHIO state of the health funds report PHI stakeholders ACCC activities PHIAC activities Appointed Actuary in PHI Topical issues in PHI Reinsurance Reform Questions Outline 2

3 Membership trends % of Pop'n with Hospital Cover 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% Medibank HEALTH INSURANCE COVERAGE Tax Deductibility Medicare & removal of Tax Deductibility Lifetime Health Cover 30% Rebate % 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% Hospital Ancillary stable in absolute numbers, falling as % of population 3

4 % 60% 50% 40% 30% 20% 10% 0% Membership trends HOSPITAL INSURANCE COVERAGE AT 31 DEC Age Group PHI PHI plus DVA Gold Card holders % of population covered

5 Membership trends HOSPITAL INSURANCE COVERAGE % of Pop'n with Hospital Cover 50% 45% 40% 35% 30% 25% 50% 45% 40% 35% 30% 25% Under age 65 Age 65 and over 5

6 Membership trends HOSPITAL INSURANCE RISK PROFILE insured population continues to age post LHC 6

7 12% 10% 8% 6% 4% 2% 0% -2% -4% -6% -8% Financial results PRIVATE HEALTH INSURANCE INDUSTRY PROFITABILITY 12% 10% 8% 6% 4% 2% 0% -2% -4% -6% -8% 7 84/85 85/86 86/87 87/88 88/89 89/90 90/91 91/92 92/93 93/94 94/95 95/96 96/97 97/98 98/99 99/00 00/01 01/02 02/03 03/04 Financial Year Underwriting Profit Total Profit Profit (% of contributions)

8 Management Expenses 25% MANAGEMENT EXPENSE RATIOS BY FUND 2003/04 Management Expenses (% of Contribution Income) 20% 15% 10% 5% 0% 0.1% 1.0% 10.0% 100.0% Market Share (log scale) 8

9 PHI price increases 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% AVERAGE CONTRIBUTION RATE INCREASES 8.0% 7.4% 7.6% 7.0% 6.8% 6.9% 4.9% 1.8% 0.0% % 9% 8% 7% 6% 5% 4% 3% 2% 1% 0% 9

10 Reports & inquiries into health financing and costs Productivity Commission Economic Implications of Ageing Australia Medical Technology Health Workforce House of Reps Standing Committee on Health Health funding (previously) long-term strategies for health/ageing Senate Community Affairs Legislation Committee Rebate reform legislation Prostheses legislation 10

11 Cost pressures on health and Health spending is 9.5% of GDP health insurance Technology advances Prostheses and other devices Pharmaceuticals Medical procedures and treatment techniques Benefits for medical services Growth in utilisation Expansion in no-gap benefits Growth in use of contracts Private hospital contracting Ageing population Consumer education & expectation Table drift 11

12 Political influences 30% rebate increased to 35% for 65-69, 40% for 70+ Medicare Levy 1% Surcharge PHIO s SOHF Reports NSW inquiry into Ambulance Service finances Oct 2004 election promises Medicare Safety Net - sustainability Medicare Gold Lifetime Health Cover horses birthday Prostheses reform Prospects of a sale of Medibank Private 12

13 PHIO state of the health funds report NHA requires PHIO to produce a yearly report providing comparative information on the performance and service delivery of registered organisations First published Feb 2005 for FY04 revised Apr page national report + 22 page report for each state Reports on service delivery offices, phone, website service performance m/ship and complaints finances and costs surplus, expenses, S&P hospital market share, concentration, coverage, price ancillary market share, concentration, benefits, processing Uses ratings A-D, that are really rankings 13

14 PHI Stakeholders DoHA, PHIAC and PHIO ACCC Privacy Commissioner Standard & Poors Global Reviews Institute of Actuaries of Australia Employment in PHI Nov 2003 IAAHS colloquium on health financing Private hospitals Doctors and other providers 14

15 ACCC activities Reports on stakeholder activities affecting competition in PHI are now 12-monthly Concern about merger between hospital groups Queensland church based hospitals Ramsay Health Care acquiring Affinity Health Interest in health insurers Interest in health providers claims for health gains 15

16 PHIAC activities On-site visits Management expense sensitivity Administrator appointed to TUH (Jun 03 to Oct 04) Administrator appointed to Federation ( 04) IFRS Changes and impact on Prudential Standards Increasing attention on Risk Management and Corporate Governance Appointed Actuary 16

17 Appointed Actuary in PHI Required involvement from July 2004 Financial Condition Report (GN 670) Rate change financial projections (GN 660) New product consultation CapAd margin advice for Prudential Requirements Risk margin in OSC (AASB 1023) Implied involvement Experience analysis Reserving (GN 650) Accounting standards and reinsurance reform 17

18 Topical Issues in PHI FBT concessions for employer-paid PHI Cover for services outside hospital that substitute for hospital services Portability between funds in the face of hospital contracting difficulties Pricing for single parents AHIA advertorials Industry mergers IOOF, IOR, GU, Federation Fund associates Healthguard, MBF Health 18

19 Reinsurance reform Current benefit equalisation scheme Risk based capitation model Reform issues Implementation timetable 19

20 Question Time 20