Private Healthcare Australia

01/04/2026

On behalf of 15 million Australians investing in health insurance, we welcome the new parliamentary inquiry into access and affordability of medical specialists in Australia.

Following consistent advocacy from PHA and health funds on behalf of their members, this inquiry will look into:
• the effectiveness and equity of referral pathways to medical specialists such as psychiatrists and surgeons
• the affordability of specialist medical care, including out-of-pocket costs in the private system
• the distribution of specialist doctors across Australia including shortages and factors affecting this
• the impact of cost delays on people’s health
• innovative and emerging models of care that may improve access for patients.

The inquiry is now accepting submissions until the 16th of October. Further information, including the full terms of reference and specific details on how to lodge a submission, are available at the Committee’s website:

On 31 March 2026, the Minister for Health and Ageing, the Hon Mark Butler MP, referred an inquiry into the access to and affordability of medical specialists in Australia to the House Standing Committee on Health, Aged Care and Disability. The Committee accepted the Minister&rsqu

27/03/2026

It’s disappointing that Australians with health insurance will have to continue subsidising the delivery of intravitreal eye injections in the most expensive setting after the government decided to back away from its decision to reclassify the simple procedure so it is performed in the most appropriate and cost-effective setting.

Even the profession’s peak body, the Royal Australian and New Zealand College of Ophthalmologists, agrees these injections are best delivered outside hospital unless there is a medical reason to do otherwise.

The reform the government has decided to abandon would have helped save people with health insurance up to $75 million a year by avoiding unnecessary hospital admissions for injections to treat conditions such as macular degeneration in consulting rooms. It would also have saved the federal government around $15 million annually through lower spending on the private health insurance rebate.

Those savings represent real pressure that could have been taken off health insurance premiums and public spending. Australia already spends substantial amounts of money on healthcare that delivers little or no clinical value.

Our healthcare system should reward appropriate care, not the most expensive location in which to deliver it. Read more insights from our CEO Dr Rachel David via Health Services Daily https://www.healthservicesdaily.com.au/why-the-government-blinked-on-eye-injections-and-why-we-will-all-pay-the-100m-price/42164

13/03/2026

Are you concerned about the cost to see a specialist doctor?

You’re not alone. Research suggests one in three Australians are delaying or skipping specialist care because they’re concerned about the price.

That’s why a current Senate inquiry into the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 is so important.

The bill would upgrade the Medical Costs Finder website so it can publish real data on specialist fees and likely out-of-pocket costs using Medicare and insurer data.
The current voluntary system hasn’t worked. Only 88 doctors have listed their fees nationwide.

If implemented properly, a stronger Medical Costs Finder website could help:
• patients understand likely costs before booking an appointment
• GPs have better conversations with patients about referral options
• reduce the fear of unexpected bills that stops people seeking care.

The Senate inquiry is now accepting submissions until 24 March.

If you support better transparency in specialist fees, consider making a submission.

And if you’ve ever navigated specialist care, your experience matters.

What was your experience with specialist fees?
Did you get a surprise bill?
Submissions can be made here:
https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/HealthAmendmentChoice

09/03/2026

Nicole's private health insurance funded her life-saving breast cancer treatment. At 45 years-old, her mammogram did not show she had cancer, but an ultrasound confirmed the diagnosis. Nicole's health cover enabled her to opt for the precise treatment she wanted, and receive it quickly.

Private health insurance is providing Australians with access to life-saving treatment when they need it.

Read Nicole's story here (The Age, subscription required): https://www.theage.com.au/money/insurance/five-years-ago-today-i-beat-breast-cancer-this-insurance-saved-me-20260306-p5o836.html

04/03/2026

Congratulations to Patients Australia on the launch of Australia’s National Telehealth Standards - an important, patient-led initiative to strengthen the safety and quality of virtual care.

Developed by the Australian Telehealth Standards Consortium, bringing together health funds and medical groups, the Standards set clear expectations across areas such as clinical governance, patient safety, informed consent, continuity of care, technology and data security.

As telehealth continues to play a growing role in Australia’s health system, consistent national standards will help build trust, support high-quality care and ensure virtual services deliver the best possible outcomes for patients.

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