Bupa calls for major health sector reforms

Australia’s largest health insurer, Bupa, is again urging large scale reform of the health system to bring costs down and improve affordability.

In a submission to a Senate Committee Inquiry Bupa is calling for the removal of waste and inefficiencies in the health system, improving transparency, empowering consumers, and changing the way people with chronic and complex health conditions are cared for.

Bupa would like the Government to establish a Productivity Commission review of the health system and develop a 10-year roadmap for structural reform of the health system.

“The Productivity Commission should be tasked with developing a 10-year roadmap to move to a ‘values-based’ health system, focused on sustainability, improved quality and greater efficiency, driven by a more effective market.”

Hospitals can play a major role in helping lower health costs

Preventing public hospitals from loading patients onto the private system is one of the company’s recommendations.

It asks that public hospitals should only be able to charge private patients for pre-booked admissions (e.g. not emergency) or if they have contracts with health insurers, with the contract to allow compliance, monitoring and audits, as per arrangements with private hospitals.

Or, if the patient signs a statement prior to admission, submitted to insurer at least 24 hours prior to hospitalisation, with the statement clearly spelling out the additional benefits that will be received as a private patient e.g. choice of doctor.

Comparator websites are costing people money

Another key plank of Bupa’s submission is that the government crackdown on comparator web sites which, while purporting to save consumers money, Bupa says actually contribute to higher prices and poorer health coverage for people.


Comparators claim as much as 40 per cent of the first year’s premium as their commission for informing people of their choice. This fee doesn't go to buying health services, it must be absorbed, and inevitably leads to higher premiums. This causes further pressure on premiums each year.
Bupa submission to Senate Committee Inquiry

Bupa wants the disclosure of full details of commissions that would be received in relation to products including up‐front and trail commissions by comparator websites.

Bupa says people are often not getting the coverage they think when they take out health insurance through comparator websites, with the fine print not explained.

It wants clear signposting of key product conditions that apply to the recommended product such as exclusions, excesses, co‐payments and waiting periods.

One solution is to bolster the government website www.privatehealth.gov.au so it provides a more consumer friendly and sophisticated comparison than is currently the case.

This, Bupa says, would create a truly independent useful comparison tool for all consumers without the payment of commissions by insurers.

Better information for patients

Bupa says the Government should work collaboratively with relevant bodies including professional associations to develop agreed performance indicators to assess the performance of health practitioners.

That data should be comparable, reliable, appropriately aggregated, benchmarked, and should account for external factors such as more complex client case-loads.

Once developed, performance indicators could be used professionally to support peer review, and externally to support patient choice.

Care in the community; mental health and rehabilitation

Based on its own customer survey data, Bupa says people want more access to rehabilitation and mental health care at home.

It found 87% of people surveyed believed mid-level psychiatric care should be delivered at home or in the community, rather than in hospital.

82% thought post-surgery rehabilitation should be conducted at home or in the community, rather than in hospital.

Bupa spent over $167 million in 2015-16 for hospital and medical benefits relating to mental health. Only 11% of the total mental spend was on same day visits.

The Government should work with the health sector, states and territories to develop new funding arrangements that incentivise the delivery of care in the community where it is clinically appropriate, Bupa says.

“We can better meet the needs of our customers, offer them a higher quality of life, and alleviate costs if we deliver more mental health care in the community or at home, rather than in hospital.”

Future health; other recommendations to government

  • Having gap free option for dental, optical, physiotherapy and podiatry services available for children - reinforcing the preventative health element- will improve the wellbeing of future generations of Australians and ultimately helping reduce the impact of chronic disease.
  • Bupa says it fully supports any reform to make Private Health Insurance more transparent and to simplify products for customers.
  • A Lifetime Health Cover Discount should be introduced for adults under the age of 30, to a maximum of a 10% discount, to encourage greater participation of younger people in health insurance.

The Australian is also reporting on Bupa's submission to a Senate inquiry on the health sector, highlighting its call for major reforms in order to bring costs down.

Read more about healthcare affordability