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Will health insurance reforms really increase cancer insurance premiums?


Industry lobby disputes the media's claims that breast cancer cover will cost more under the government's health care reforms.

Private Health Care Australia, the peak body representing the health insurance industry, lashed back against recent claims that breast cancer patients will pay more for treatment than people who suffer from other forms of cancer. They say the government's forthcoming gold/silver/bronze rating system is not a mandate to insurers to change their levels of cover, just like how the energy rating level is not a mandate for an appliance to have a particular level of efficiency.

“We wish to reassure the cancer representative organisations named in the report there will be no changes to the cover offered for breast cancer. Health funds agreed to participate in a government process to help consumers choose and use their health insurance, which has been running since 2016 and which will soon conclude. This involves a classification of products into four tiers, standardisation of clinical definitions to define treatment areas, improved information for consumers and improvements to the Ombudsman’s website. At no point have we agreed to reducing the cover offered for breast cancer," Private Healthcare Australia chief executive Rachel David told finder.

However, the Breast Cancer Network and the Cancer Council say the government will allow insurers to cut a number of important medical treatments from the bronze and silver categories, meaning more and more people will be thrust into the more expensive gold category if they want the treatment they need. They say breast cancer patients will be among those affected, even more so than people with other forms of cancer.

Under the current framework, all cancers are treated the same, with in-hospital services being covered under most hospital policies and outpatient services like ongoing chemotherapy treatments being largely excluded.

Cancer advocates say proposed changes to the new classification system (which have not been made public) will classify cancer based on where it occurs in the body, allowing patients with some forms of cancer to access treatments under bronze and silver policies while others like breast cancer patients will need gold policies.

They use lymph node removal and breast reconstruction surgeries as examples. However, many cancers can spread to the lymphatic system, so it is unclear how changes to lymphatic treatment would affect breast cancer patients any more or less than other cancer patients.

In regard to plastic surgery, many entry-level policies cover cosmetic surgery and limit it to procedures that are medically necessary (including breast reconstruction). So, again, it is unclear how the new classification system could add any new hurdles that don't already exist for breast-cancer patients needing reconstructive surgery.

That's not to say there's not more that can be improved to make the private healthcare system work better for breast cancer patients. One study found that breast cancer patients end up paying an average of $5,000 in out-of-pocket treatment costs, even with private health insurance.

Reducing out-of-pocket costs for all patients is another issue the reforms hope to address.

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