Australian health insurance statistics 2018

Health funds by market share

Health fund admin fees

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.

Complaint by market share

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:

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

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

^{_{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.