Health plan payment in Australia
The Australian healthcare system is characterized by a mix of public and private financing and provision of healthcare services. The health insurance system consists of a National Health Insurance/Service and voluntary private health insurance (PHI). The latter is regulated through the Private Insurance Act (2007) which established a complex mix of subsidies and regulatory instruments (e.g., community rating, open enrollment, ad valorem premium-subsidies and tax-incentives), and provides for the operation and administration of the Risk Equalization Trust Fund. The Australian health plan payment scheme constitutes a combination of risk sharing and risk equalization. The duplicative nature of the current private/public mix (those with PHI remain covered by the national public system) and the potentially inefficient mix of subsidies have contributed to some important issues such as overinsurance, a high market concentration, risk selection, market segmentation, and a misallocation of subsidies. Increasingly, concerns are rising about the affordability, efficiency, and sustainability of the Australian healthcare system.
|Keywords||Australia, Private health insurance, Risk equalization, Risk sharing|
|Persistent URL||dx.doi.org/10.1016/B978-0-12-811325-7.00006-3, hdl.handle.net/1765/126260|
Paolucci, F, Sequeira, A.R, Fouda, A.M.M.A, & Matthews, A. (2018). Health plan payment in Australia. In Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice (pp. 181–208). doi:10.1016/B978-0-12-811325-7.00006-3