Australian Society of Anaesthetists responds to Private Health Australia’s claims on out-of-pocket costs

While there is no dispute that many Australians face growing healthcare cost pressures, the ASA believes that a meaningful discussion must also take into account the increase in private health insurance (PHI) premiums and the lack of indexation with Medicare benefit rates.

“While we recognise the very real pressure on patients, the notion that specialist out-of-pocket cost increases can be viewed in isolation is misleading,” says ASA President Vida Viliunas.

“The broader system context—including rising insurance premiums and insurer profitability—must be part of the conversation. If the PHI industry is charging households more yet paying out relatively less, then we risk having patients caught in the middle: meeting higher premiums, facing higher gaps, and specialists absorbing pressures too,” Dr Viliunas stated.

The ASA calls on all stakeholders—including consumers, insurers, medical specialists, hospitals and government—to engage in a comprehensive review of:

1. The level and nature of out-of-pocket costs for specialist care (including anaesthesia) in the private sector.
2. The growth in PHI premiums and how they compare with benefit payouts, gap sizes and indexing arrangements.
3. Transparency in cost drivers: what proportion of premium increases is attributable to insurer administration and profitability, versus clinical/technology cost escalation.
4. Policy reforms which ensure that patients are not disproportionately burdened by dual cost increases—both via premiums and out-of-pocket bills.

“The private specialist sector is a proud contributor to high quality patient care, but with the dual pressures of insurance-cost escalation and gap growth, something needs to give. We urge the PHI industry and the government to work with us to deliver a sustainable, transparent system that treats patients fairly, supports specialists and keeps the total cost curve in check.  Afterall, the more we prevaricate on these issues the focus on the provision of high quality patient focussed care and good outcomes is clouded,”  Dr Viliunas concluded.

About the Australian Society of Anaesthetists
The ASA represents anaesthetists working across Australia in private, public and mixed practice settings. Our mission is to promote and support high-quality anaesthesia care, advocate for safe working conditions and fair remuneration, and ensure that patient access to specialist anaesthesia is preserved and enhanced.

Leon Beswick / 0414 332267