Private Healthcare Australia

18/02/2026

Health Minister Mark Butler has announced private health insurance premiums will increase by an average of 4.41% this year. This rate reflects rising claims for care and the higher cost of delivering health services in Australia, including wages for healthcare workers.

Health funds know the cost of healthcare is hitting consumers hard, so we are focussed on:

- Delivering more ‘no-gap’ fee and ‘known-gap’ fee private health services to give people greater certainty about costs when they need care.
- Expanding health management and prevention programs to help people stay well and reduce the need for more expensive hospital care in future.

Private health insurance continues to provide the highest return of any type of insurance in Australia. For every dollar you spend on health insurance, 85 cents is spent on healthcare.

Read more here: https://privatehealthcareaustralia.org.au/health-insurance-premiums-to-rise-as-healthcare-costs-and-claims-increase/

12/02/2026

We welcome the Albanese Government's legislation to upgrade the Medical Costs Finder website. This is a crucial step toward tackling Australia's growing specialist fee crisis.

The reform will expand information available about specialist doctors’ fees, allowing patients to compare typical costs before booking an appointment and better estimate their likely out-of-pocket expenses.

The announcement comes after the release of our Restoring affordable access to specialist care in Australia report, backed by a nationally representative survey of more than 4,000 Australians. The report revealed the rapid rise in fees to see specialist doctors, outpacing inflation, and the prevalence of illegal "booking and "admin" fees.

Health funds stand ready to contribute more data to the upgraded Medical Costs Finder website to help consumers use private healthcare more confidently.

Read our full statement here: https://privatehealthcareaustralia.org.au/health-funds-back-stronger-transparency-laws-for-specialist-doctor-fees/

05/02/2026

A national survey of more than 4,000 Australians reveals widespread concern about access to specialist doctors, particularly fees and billing. The survey found:

- 1 in 3 Australians have delayed or cancelled specialist care due to cost in the last three years
- 38% received a bill they were not expecting, with 55% receiving a larger bill than anticipated
- 29% were charged potentially illegal administration or booking fees not visible through Medicare
- 19% were asked to pay non-refundable deposits before their appointment

A new report out today, “Restoring affordable access to specialist care in Australia”, shows specialist fees for in-hospital care have jumped 22% since 2022.

This trend is reshaping how Australians use our mixed public-private heath system, and it reducing demand for private hospitals. We want a series of reforms to help reduce visible and hidden costs in the private health system.

See our full release here for more information: https://privatehealthcareaustralia.org.au/australians-demanding-action-to-keep-medical-specialist-fees-affordable-research-reveals/

14/01/2026

Did you know you that Medicare won’t always cover your healthcare expenses on an Australian cruise ship? For more than 1.3 million Australians who go on cruises each year, it's worth looking into travel insurance, even if you’re just sailing around Australia.

Consumer advocacy group Choice says Australians may need either international travel insurance or a domestic cruise insurance policy to avoid medical bills. This is because doctors working on cruise ships may not have Medicare provider numbers, meaning you can't claim on your Medicare or private health insurance.

Read more here: https://www.canberratimes.com.au/story/9145613/the-hidden-costs-of-aussie-holidays-without-travel-insurance/?cspt=1768345720|71690affeb8bf6758f6abc27648d711c

14/01/2026

Allegations of secret payments linked to medical device suppliers in Queensland highlight serious gaps in how medical devices are regulated in Australia.

Unlike pharmaceutical companies, medical device companies are not subject to mandatory public reporting of gifts, discounts, or other transfers of value to doctors and hospitals.

Private Healthcare Australia has long called for reform, including:
- Mandatory public reporting of all incentives and discounts.
- An enforceable code of conduct for medical device companies, aligned with the pharmaceutical sector.
- Strong penalties for non-compliance.

Opaque commercial arrangements can distort clinical decision making with risks for patient safety. They can also inflate healthcare costs which ultimately flow through to consumers.

Greater transparency will help protect patients and ensure Australians are getting value for money from our health system.

https://www.abc.net.au/news/2026-01-14/neurosurgeon-charged-crime-corruption-commission-investigation/106226408

12/01/2026

Australians deserve affordable access to high-quality, high-value health care, but hospital viability also depends on Australians being able to afford private health insurance.

PHA welcomes discussion around transitioning to a private national efficient price, however the model proposed is likely to undermine the health system rather than strengthen it.

Our modelling shows what is proposed could increase hospital care costs by $800 million to $1.2 billion each year without any meaningful improvement in standards of care. It could also see around 560,000 people drop out of the private health insurance system.

The result? Significant pressure on private hospitals and health funds, greater strain on the public system, and a real risk of declining hospital care standards across Australia.

Read our response to the government’s proposal here:https://privatehealthcareaustralia.org.au/wp-content/uploads/20251124-PHA-response-to-Pricing-Framework-for-Australian-Private-Hospital-Services-Draft.pdf , or via Financial Review at https://www.afr.com/companies/healthcare-and-fitness/insurers-warn-labor-of-private-health-exodus-under-funding-shake-up-20260105-p5nrtn.

18/12/2025

If you have hip pain, this is a great explanation of the steps you can take to investigate it and explore treatments on offer.

As Charlotte Ganderton and Joshua Heerey write, most hip conditions can be well managed with non-surgical treatments, such as exercises or stretches prescribed by a physiotherapist, doctor or other health-care professional.

You should start by seeking a thorough clinical examination from a trained and registered doctor or healthcare professional such as a physiotherapist who may recommend scans to help diagnose the cause of your pain.

https://theconversation.com/why-does-my-hip-hurt-hip-pain-can-have-many-causes-and-mostly-doesnt-require-surgery-265871

11/12/2025

We commend St Vincent's commitment to deliver half of its health and aged care in people's homes or through virtual platforms by 2030.

PHA has long advocated for increased access to healthcare outside of hospital settings as Australians seek more convenient, personalised care. St Vincent's plan will help more people access care, especially those in rural and regional areas, it will create more flexibility for healthcare workers to do their jobs, and it will free up our hospital resources for the people who need them most.

Our health system is already delivering more care in people’s homes, including post-surgical care, wound management, chemotherapy, and mental health care. But the evidence is clear: we need more of this innovation to create a health system that will meet the needs of our ageing population into the future.

Read more here: https://www.svha.org.au/news/latest/half-of-st-vincent-s-health-and-aged-care-to-be-provided-at-home-or-virtually-by-2030

10/12/2025

Medical billing is complex, and many Australians end up confused about what they’re being charged, especially at a time when cost-of-living pressures are front of mind.

A new book by Dr Margaret Faux, How to Avoid the Medical Bill Rip Off!, offers a practical, plain-English guide to understanding the system. It walks readers through how to choose the right doctor, what to ask before a procedure, and how to avoid hidden or unnecessary fees. The book includes real examples of Australians who reduced their out-of-pocket costs simply by knowing their rights and asking better questions.

The Sydney Morning Herald has shared several helpful excerpts. Read more: https://www.smh.com.au/national/we-have-a-healthcare-system-where-confusion-reigns-and-the-patient-suffers-20251204-p5nksw.html

03/12/2025

Health funds have returned almost $4.8 billion to members in claims savings and givebacks since the Covid-19 pandemic.

During the pandemic, health funds made a promise not to profit from reduced access to health services during lockdowns and restrictions put in place to limit the spread of the virus. They committed to return savings to members through a range of measures, including:

- cashbacks into members’ bank accounts
- deferred and cancelled premium rises, so members paid less for their health insurance
- rollover of extras limits to the following year
- financial hardship packages for people who couldn’t afford to pay their premiums
- expanded cover to include ‘lung and chest’ problems (COVID-19) without charging more for it.

Figures released by the ACCC show health funds have fulfilled this commitment.

More here: https://privatehealthcareaustralia.org.au/health-funds-return-almost-4-8-billion-in-savings-and-givebacks-to-members-new-official-figures-show/

28/11/2025

Health insurers paid out a record $9.4 billion in 'high claims' exceeding $10,000 for hospital treatment in 2024 - a 10% increase on the previous year. These high claims accounted for more than half of all hospital benefits paid by health insurers in 2024, demonstrating the real-world value of hospital cover for thousands of people who used it last year.

Our 2025 Annual Hospital High Claims Report reveals more than 1,000 people were hospitalised with serious conditions that resulted in payments of more than $100,000 each. Their conditions included heart disease, severe infections, cancers, diabetes, and schizophrenia, as well as complications from spinal fusion surgery. Many spent months in hospital. Some spent up to two years in hospital.

The highest paid claim was $697,267 for treatment of severe mitral valve disease with a heart valve replacement that ended with complications.

The report shows how valuable health insurance can be in a health crisis, and how much pressure it takes off our public hospital system.

Read our full report here: https://privatehealthcareaustralia.org.au/half-of-all-health-insurance-claims-for-hospital-care-in-2024-exceeded-10000-new-data-shows/

25/11/2025

Healthy people are paying thousands of dollars for unneeded full-body MRI scans in the hope it will detect early signs of illness. These scans often pick up harmless "incidental findings", causing patients to undergo more tests, including invasive surgical procedures, which can be costly and deliver no real benefit.

Screening for diseases is important when it is supported by scientific evidence and strong clinical guidelines that have balanced the potential harms and benefits, however blanket screening can do you more harm than good. If you want to prevent diseases and maximise your chance of early intervention, speak to your GP about evidence-based tests and screening programs you should engage with.

Read our CEO's comments in today's article in The Age about full-body MRI scans:

A boom in private clinics offering full-body medical scans for patients with no symptoms is leading to unnecessary anxiety, misdiagnoses and invasive investigations, some doctors say.