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Topics in this section Private Patients' Hospital Charter Insure? Not Sure? (pdf format) Operations Of The Private Health Insurers Annual Report Financial and Statistical tables of past Operations Annual Reports |
PublicationsOperations Of The Private Health Insurers Annual Report 2006-07Readers NotesThe Private Health Insurance Act 2007 and associated Acts and Rules that commenced on 1 April 2007 included changes in the data collected by PHIAC. There have been changes in the definitions and classification of data items compared to previous PHIAC annual reports. Definitions of terms can be found in the glossary. ‘Contributor’ changed to ‘policy’PHIAC has historically used the term ‘contributor’ to refer to a policy with a private health insurer. This and consequent reports will refer to policies. Policies should not be confused with policy holders. A policy holder is an adult covered by the policy. A policy could have one, two or more policy holders. Categories of membership and changes in this reportInformation about two additional categories of policy are now collected by PHIAC. These categories are ‘2 + persons no adults’ and ‘3+ adults’. In this report these categories are combined, where appropriate, with the category of ‘family’ to allow historical trends to be shown. The definition of single equivalent unit (SEU) has changed from that used in previous reports. The ‘single parent’ category is now defined as one SEU rather than two. Where historical data of benefits per SEU is shown, PHIAC has used the current definition of SEU. For this reason, historical benefits per SEU shown in this report will differ from previous annual reports. In this report the historical term ‘ancillary policy’ is replaced by ‘general treatment policy’. General treatment policies include cover for the historical ancillary items such as dental and optical and also include the new categories of hospital-substitute treatment and chronic disease management program treatment. In previous reports many of the policies reported under the category of ‘hospital only’ had a component covering ambulance transport. Ambulance transport has been formally defined under the Act as general treatment, so many of the policies previously reported as ‘hospital only’ are now categorised as policies covering a combination of hospital and general treatment. This change caused an artificial increase in the number of general treatment policies and an artificial decrease in the number of ‘hospital only’ policies, causing a significant structural break in the historical series. Changes in benefit categoriesTwo new categories of treatment benefits are reported in this report:
Hospital-substitute treatment is included in general treatment. However, this report categorised hospital-substitute treatment with other hospital treatment (see table 23). Change from reinsurance to risk equalisation and the effect on data reported by stateIn previous reports the data reported by state was either under-reported or over-reported in most states as a consequence of the reinsurance arrangements. Insurers with less than a certain number of policies (500 SEUs) in a state reported data for that state in their major state. Under risk equalisation, introduced on 1 April 2007, insurers are required to report in every state regardless of the number of SEUs in that state. As a result, the data reported as at 30 June 2007 for policies and persons more accurately reflects the actual number of policies and persons by state of residence than data reported for previous years. Changes in medical services and benefits reportingDue to legislative changes in the way data is collected from the June quarter 2007, medical services in this report are shown for those services where benefits were paid up to the schedule fee only and for those services where benefits were paid above the schedule fee. The sum of the number of services for these two categories is the total number of medical services. In previous annual reports PHIAC reported the total number of medical services under ‘Up to schedule fee’. The services reported under ‘Above schedule fee’ was a subset of ‘Up to schedule fee’. The medical benefits reported in ‘Up to schedule fee’ included only services where benefits were paid up to the schedule fee. ‘Above schedule fee’ included only benefits that were paid above the schedule fee. |
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