Australian health insurance statistics 2017

Your data compendium for everything from complaints and premium rises to the most claimed for extras services and most popular policy types by state or territory.

As the cost of private health insurance continues to rise in line with spiralling healthcare costs, recent surveys indicate widespread public dissatisfaction with health funds. They also indicate that a growing number of people are thinking about reducing or ending their cover.

But do the figures support this? Let's take a look at the latest health insurance statistics from the side of industry and consumer to see how health funds are performing, who has cover, what they’re getting in return for it and whether Australians really are ditching their health insurance.

Health fund office icon

Industry statistics covered

    • Health funds by market share
    • Average annual policy premium
    • Average health fund admin fees per policy
    • Industry premium price rises for 2017
    • Health fund premium rises since 2010
    • Complaints by market share

Health insurance consumer icon

Consumer statistics covered

    • Percentage of Australians covered by age
    • Percentage of Australians covered by region
    • The type of cover people are getting
    • The most popular extras services
    • Average out-of-pocket expenses
    • Australians dropping cover

Stethoscope and statistics

Health funds by market share

Health fundMarket shareAverage policy value
Medibank Private Limited27.60%$3,313
Bupa Australia Pty Limited27.00%$3,494
HCF Limited10.30%$3,595
NIB Health Funds Limited8.10%$3,022
HBF Health Limited8.00%$2,960
Teachers Federation Health Limited6.40%$3,851
Australian Unity Health Limited3.10%$3,286
GMHBA Ltd2.10%$3,126
Defence Health Limited1.80%$3,554
CBHS Health Fund Limited1.40%$3,973
Health Insurance Fund of Australia Limited0.90%$2,669
Latrobe Health Services Limited0.70%$3,419
Westfund Limited0.70%$3,653
CUA Health Limited0.60%$3,412
Health Partners Limited0.60%$3,441
Lysaght Peoplecare Limited0.50%$3,808
Railway and Transport Health Fund Limited0.40%$4,364
St Luke's Medical and Hospital Benefits Association Limited0.40%$3,809
Grand United Corporate Health Limited0.40%$5,413
Queensland Country Health Fund Limited0.30%$4,442
Navy Health Limited0.30%$3,726
Police Health Ltd0.30%$5,169
Mildura District Hospital Fund Limited0.20%$2,716
Transport Health Pty Ltd0.10%$3,020
Cessnock District Health Benefits Fund Limited0.10%$3,842
Health Care Insurance Limited0.10%$3,823
Phoenix Health Fund Limited0.10%$4,330
National Health Benefits Australia0.10%$4,987
ACA Health Benefits Fund Limited0.10%$5,612
Reserve Bank Health Society Limited0.10%$7,714

Health fund admin fees

Health fundAdmin fees per policy per yearPortion of admin fees that make up an average policy
Defence Health6.50%$231
Teachers Federation6.70%$258
CBHS7.40%$294
National Health Benefits7.50%$374
Bupa7.90%$276
HCF Limited7.90%$284
Medibank Private8.00%$265
Mildura District Health8.10%$220
Police Health8.30%$429
ACA Health8.50%$477
Industry8.50%$288
NIB8.90%$269
Phoenix9.10%$394
Health Partners9.30%$320
Latrobe9.30%$318
Navy Health9.50%$354
Queensland Country Health9.50%$422
CUA Health9.70%$331
Peoplecare9.90%$377
Transport Health10.00%$302
HBF10.10%$299
GMHBA10.30%$322
The Doctors' Health Fund10.60%$518
TUH10.90%$475
St Luke's11.00%$419
Australian Unity11.20%$368
Cessnock District Health11.40%$438
Westfund11.80%$431
Reserve Bank Health11.90%$918
Health Care Insurance12.40%$474
HIF13.00%$347
Railway and Transport14.30%$624
Grand United Health15.50%$839

Health fund premium rises in 2017

  • The average annual policy premium for 2017 is currently around $3,388. Policies range in value depending on level of cover.
  • On average, premiums rose by 4.84% on April 1st 2017.
Health fundPremium increaseAverage policy cost
Railway and Transport5.54%$4,364
CUA Health4.97%$3,412
Transport Health4.93%$3,020
NIB4.48%$3,022
Cessnock District Health6.57%$3,842
Police Health4.63%$5,169
Health Care Insurance6.06%$3,823
Phoenix5.93%$4,330
GMHBA4.94%$3,126
HCF Limited3.65%$3,595
CBHS3.29%$3,973
Peoplecare5.09%$3,808
Medibank Private4.60%$3,313
National Health Benefits5.41%$4,987
TUH7.30%$4,358
Health Partners5.10%$3,441
Bupa4.90%$3,494
Australian Unity4.46%$3,286
Latrobe4.49%$3,419
Westfund4.96%$3,653
ACA Health4.70%$5,612
Teachers Federation4.96%$3,851
HBF5.96%$2,960
HIF7.99%$2,669
St Luke's4.99%$3,809
Mildura District Health5.95%$2,716
Queensland Country Health5.15%$4,442
Defence Health5.51%$3,554
The Doctors' Health Fund3.54%$4,887
Reserve Bank Health5.00%$7,714
Navy Health4.94%$3,726
Grand United Health4.11%$5,413

Complaint by market share

Health fundPortion of complaintsMarket share
CUA Health1.80%0.60%
Australian Unity5.10%3.10%
Medibank Private40.20%27.60%
HCF Limited10.60%10.30%
NIB7.80%8.10%
Bupa21.70%27.00%
HIF0.60%0.90%
GMHBA1.40%2.10%
CBHS0.90%1.40%
Latrobe0.40%0.70%
Health Partners0.30%0.60%
Westfund0.30%0.70%
HBF3.30%8.00%
Peoplecare0.20%0.50%
Defence Health0.70%1.80%
TUH0.20%0.60%
Teachers Federation1.20%6.40%

How many Australians have health insurance?

According to the latest statistics from APRA, 47% of Australians currently have hospital cover and 55.7% have extras cover. This is further broken down into age groups as follows:

Age bracketHospital coverExtras cover
0 – 14 years17.9%18.8%
15 – 64 years65.0%66.2%
65+ years 17.0%15.0%

Source: http://www.apra.gov.au/PHI/Publications/Documents/1611-QPHIS-20160930.pdf

Now let's break it down by age and region:

LocationHospital coverExtras cover
ACT58.1%68.5%
NSW47.9%57.6%
NT40.9%44.3%
Queensland45.3%50.2%
SA46.0%59.4%
Tasmania44.8%51.6%
Victoria44.5%51.1%
WA55.0%68.4%

Source: http://www.apra.gov.au/PHI/Publications/Documents/1611-QPHIS-20160930.pdf

This shows us that ACT and WA have the greatest percentage of cover and NT has the least. It also shows that more Australians overall have extras cover than hospital cover.

What type of cover are people getting?

A higher percentage of Australians have extras cover than hospital cover and the only exception to this is in the 65+ age group. Slightly more people in this group have hospital than extras cover (17% vs 15%) and claim more for hospital services than younger demographics. This is not surprising given that older people are more likely to require and use hospital services.

According to APRA’s report, private health funds paid out $1,154 million in ancillary (extras) benefits in the last quarter of 2016. The proportion paid for the most popular ancillary services was as follows:

  • Dental. $619 million
  • Optical. $176 million
  • Physiotherapy. $101 million
  • Chiropractic. $71 million

This clearly shows that most people take out extras cover for dental services, which Medicare does not cover. However, unlike hospital cover where the older demographic had a higher claim rate, the percentage of extras cover held and claimed for was fairly evenly spread among the age groups.

Out-of-pocket (gap) payments

The APRA report also showed that the average out-of-pocket (gap) payment for a hospital episode was $284 in the September quarter of 2016, which is a 1.7% reduction compared to the same quarter of 2015.

The average out-of-pocket payment for general (extras) medical services was $129. The average for specialty services, such as plastic surgery, was $341 and $318 for orthopaedics. The average gap also varied by state and territory.

Are Australians ditching their health cover?

The APRA report shows that a healthy proportion of Australians still hold both hospital and extras cover and reductions in numbers on previous years are only very minor (health fund memberships dropped from 47.4% to 47.0% during the year to June 2016).

So given these statistics, are Australians really ditching their private health cover? The surveys certainly indicate dissatisfaction with private health funds. A survey of 2,005 Australians conducted by finder.com.au found that 15% of people surveyed are preparing to cancel their cover and nearly half of those (44.7%) blamed increasing premium costs for their decision.

Another recent poll, commissioned by the Medical Technology Association of Australia (MTAA), revealed that 77.9% of Australians believe private health funds are motivated by money and put profits ahead of patients.

Given that the public health system is struggling to cope with inadequate funding, increased waiting times and fewer beds, the growing dissatisfaction with private health cover is a worrying trend. But if you look at the statistics, around half of all Australians now hold private health cover, and there seems to be little evidence of a major swing away from private health insurance. We will probably have to wait to see what the next round of statistics reveals and continue to shop around in earnest for the best value cover we can find.

If you have any queries about these statistics, please contact Sophie Walsh either by emailing sophie.walsh@finder.com or calling 0404 576 822.


Ask an Expert

You are about to post a question on finder.com.au:

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Finder only provides general advice and factual information, so consider your own circumstances, read the PDS or seek advice before you decide to act on our content. By submitting a question, you're accepting our Terms and Conditions and Privacy Policy.
Ask a question
feedback