Summary of the thirteenth meeting of the Private Health Ministerial Advisory Committee, 11 April 2018, Department of Health offices (Scarborough House), Canberra.

This page contains information on the Private Health Ministerial Advisory Committee – Meeting Summaries

Page last updated: 04 May 2018

Printable version of the Meeting Summary 11 April 2018. (PDF 138 KB)


Members Secretariat
Dr Jeffrey Harmer AO, Chair Susan Azmi, Secretariat
Michael Roff, Australian Private Hospitals Association Margaret Noris, Secretariat
Philip Truskett AM, Royal Australasian College of Surgeons Debbie Hurlbut, Secretariat
Matthew Koce, Members Health Josh Shanahan, Secretariat (Item 2 & 3)
Jane Griffiths, Day Hospitals Australia Jane Ranson-Smith, Secretariat (Item 3)
Dr Rachel David, Private Healthcare Australia Anne Dwyer, Secretariat (Item 2a)
Garry Richardson, Expert member Charles Maskell-Knight, Secretariat
Toby Hall, St Vincents Health Australia Mitch Docking, Secretariat (Item 2a)
Mark Cormack, ex-officio Pierre Nijssen, Secretariat
Nicole Keeling, Secretariat
Peta McElgunn, Secretariat
Tristan Gairey, Secretariat (Item 2e)
Proxies Other Attendees

Andrea Kunca, Medical Technology Association of Australia
Jo Root, Consumer Health Forum
Sue McGrath, COTA
Luke Toy, Australian Medical Association

Julianne Quaine, Department of Health, Observer
Alex Caroly, Senior Adviser to the Minister for Health
Jaala Hinchliffe, Private Health Insurance Ombudsman Office
David McGregor, Private Health Insurance Ombudsman Office


Ian Burgess, Medical Technology Association of Australia
Anne Trimmer, Australian Medical Association
Ian Yates AM, COTA
Marcus Dripps, Allied Health Professions Australia
Penny Shakespeare, Department of Health

Welcome, apologies and introductions

  • The Chair noted apologies for this meeting.

1. Implementation of Reforms Update

(a) Improved Models of Care (IMOC) Working Group

  • The Secretariat provided an update on the first meeting of the Improved Models of Care Working Group, held on 20 March 2018.
  • The key themes arising from the meeting were: current regulation may act as a barrier to funding more efficient settings of care; the importance of maintaining independent clinical decision-making; patients should not be restricted in their choice of setting; the risk of shifting costs onto patients; and affordability and system sustainability.

(b) Mental Health Reform

  • The Secretariat provided an update on the new mental health coverage requirements which came into effect on 1 April 2018. The Committee noted that the mental health waiting period exemption had been utilised by a number of consumers since the commencement of the changes. The Secretariat acknowledged the delays in finalising the Rules and thanked insurers and hospitals for their input and their understanding.

(c) Ministerial Advisory Committee on Out-of-Pocket

  • The Secretariat provided an update on the progress of the work of the Ministerial Advisory Committee on Out-of-Pocket Costs (the Committee). The members were advised that the Minister attended the second meeting of the Committee and reinforced the need for a best practice model to make information on out-of-pocket costs to be more transparent.
  • The members noted that models for improved transparency are currently being developed for the Committee’s consideration at its next meeting in June.

(d) Private Health Information Statement

  • The Secretariat provided an update on consumer testing of the product design, clinical definitions and minimum data set reforms, which is currently under way. The findings will assist to inform the development of the new Private Health Information Statement (formerly known as the minimum data set).

(e) Second tier

  • The department has grouped declared private hospitals into second-tier hospital categories and found that they largely align with the Australian Institute of Health and Welfare (AIHW) private hospital peer groups.
  • AIHW currently does not update the peer groups for private hospitals on a regular basis and there are approximately 165 declared facilities that are not included in the peer groups (the majority of which are day hospitals).
  • The department will circulate its draft second-tier hospital categories to private hospitals and peak bodies for consultation shortly and stakeholders will have one month to provide comment.
  • The Australian Commission on Safety and Quality in Health Care will commence consultation on the inclusion of informed financial consent in the private hospital accreditation process in July. Consultation will follow the Commission’s usual processes with the aim of including informed financial consent in the accreditation process from 1 January 2019.
  • The department is reviewing its cost recovery model for second-tier administration fees against its proposed assessment process.
  • The Private Health Insurance Legislation Bill 2018 provides a legislative basis for the department to charge application fees for second-tier eligibility. The fee will be specified in the Private Health Insurance Rules.
  • The department is considering the balance between what goes in the Private Health Insurance Rules and what goes in second-tier guidelines.
  • The department is considering establishing a working group in June/July to consider an appropriate inflation factor to index second-tier default benefits and welcomes nominations from PHMAC members for participants.

2. Product Design

  • The Secretariat provided the Committee with a revised draft of the Gold/Silver/Bronze/Basic hospital product categories for final feedback.
  • The Committee noted the department has allocated Medical Benefits Scheme (MBS) items to the draft standard clinical definitions in preparation for formal consultation with PHMAC members, insurers and clinician groups.
  • Members discussed the draft general treatment product categories and agreed further development work on category parameters should closely reflect the insurance products currently offered by insurers. The Committee requested that the Secretariat work with insurers to progress the general treatment categories.
  • Members noted that Deloitte and Whereto Research Based Consulting are undertaking further work to inform the final product design.

3. Update of legislation including Benefit Limitation Periods

  • The members noted that the Private Health Insurance Legislation Bill 2018 and associated taxation amendments bills were introduced into Parliament on 28 March 2018. The legislation also included provisions relating to benefit limitation periods.
  • The Secretariat also advised that a number of the elements of the reform package are not included in the Bills as they will be addressed in the Private Health Insurance Rules. The Rules will be made following the passage of the legislation. The members were advised that an exposure draft of the Rules will be released at the end of May.

4. Summary report – Rural Private Health

  • The Committee noted the summary report of the Rural and Regional Private Insurance Discussion Working Group. The Chair acknowledged the work undertaken by the working group.
  • Members were advised that the government will consider the impact of the changes relating to the travel and accommodation benefits reform before making any decision on implementing further reforms in this area.

5. Update on Private Patients in Public Hospitals

  • The Committee noted that the issue of private patients in public hospitals was addressed in the Heads of Agreement on public hospital funding and health system reform considered by COAG at its meeting on 9 February 2018.

6. Update by Private Health Insurance Ombudsman – PHI Reforms

  • The Deputy Ombudsman, Office of the Commonwealth Ombudsman, Jaala Hinchcliffe, and David McGregor, Director, Private Health Insurance Ombudsman (PHIO) provided an update for the Committee on PHIO’s approach to implementing the PHI reforms and how implementation is progressing.

7. Other Business

  • The Committee noted that its next meeting is scheduled for Tuesday, 12 June 2018.

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