Private health insurance reforms: Improved Models of Care Working Group

The Private Health Ministerial Advisory Committee has established a Working Group to ensure that mental health and rehabilitation services funded by private health insurance are both clinically effective and delivered efficiently

Page last updated: 16 July 2018

Private health insurance reforms: Improved Models of Care Working Group (PDF 97 KB)

  • The Improved Models of Care Working Group provides advice to Government on options to best support consumers’ access to clinically effective and efficient care.
  • The Working Group includes consumers, clinical experts and representatives from the health insurance and private hospital sectors.
  • The issues and options identified by the Working Group may extend beyond mental health and rehabilitation to other clinical areas which have admission rates that are higher than clinically necessary or inefficient.
  • The Working Group was established in early 2018.

Why is this important?

  • There is evidence to suggest that the existing funding arrangements for private health insurance provide inappropriate incentives for some patients to be admitted to hospital for mental health and rehabilitation services, when it may be more clinically appropriate and efficient to deliver services in a non-admitted or community based setting.
  • This adds to the cost of care and leads to higher private health insurance premiums.
  • Consumers have also raised concerns that in some instances patients would prefer to be treated in out-patient setting, but the private health insurance rules may not always fully support this consumer choice.

Who will benefit?

  • The elimination or replacement of admissions that deliver low value or inefficient care will help to deliver better standards of care to patients. It will also generate savings, which will lower premium increases for policy holders.

What impact will this change have on private health insurance?

This change will support the Government in considering future reforms to provide improved care to Australians with private health insurance.