Aussies Health system

[BEVUP]

Australian capitalism’s sheltered workshop, the private health insurance industry, is burning billions of dollars a year unrelated to Australians’ health.

Thursday’s latest statistics for the year to the end of March show the industry increased its gross margin to 14.4 per cent, up from 13.6 over the previous corresponding period.

Premium revenue rose 4 per cent, to $23.75 billion, while the insurance companies’ benefits payments increased by 3 per cent to $20.1 billion.

The resulting health insurance gross margin of $3.65 billion went on expenses of $2.21 billion, tax of $441,000, state ambulance levies of $226,000 and net profits of $1.38 billion.

Thus private health insurers spent $3.65 billion on stuff other than the medical needs of their customers. That’s money that didn’t pay for hospitals, doctors, nurses, drugs, prostheses or even the sundry ancillary benefits that are a dubious insurance proposition for customers – dental, physiotherapy, optical and chiropractic.

This is an industry that enjoys the federal government acting as its enforcer, pushing customers through its doors, using the cattle prod of tax penalties. It then blows 14.4 per cent of the money customers pay on things other than health care.

Some of that money goes on lobbying the government to ensure the perpetuation of two-class health care. The private insurance companies need at least the perception of the public system being second-rate as part of its sale pitch.

Despite the government’s tax carrots and sticks, most Australians – 54.5 per cent – didn’t have hospital treatment cover on March 31. That’s up from 53.1 per cent five years ago. The general treatment sales effort has been more successful – 54.6 per cent of us buy it, similar to the 54.7 in 2013.

The numbers on private cover vary widely, but many Australians don’t have any. Source: APRA

The industry’s grand ambition was spelt out last year by the CEO of one of the two ASX-listed insurers, NIB. Mark Fitzgibbon told the AFR he wanted to bring back the days before Medicare.

“We need to be thinking about how do we create a future in which 70 per cent of the population have health insurance, as it did before Gough Whitlam introduced Medicare,” he said.

“If we spend all our time defending what we’ve got, we’ll never get that 70 per cent of the population. So what kinds of policy changes and settings do we need to incite consumers to that level of participation? What else can we do to give people another reason for having health insurance, particularly young people?”

Shamelessly propped up by the tax system, the double act of private hospitals and private health insurance push the line that public hospitals couldn’t cope without them, ignoring the inefficiencies of maintaining two systems and what the money spent on private hospitals and insurance could achieve if added to the public hospital budget. Just for a start, there’s that $3.65 billion of health insurance premiums that went nowhere on health in the latest year.

Australia’s mishmash of state-run public hospitals and private hospitals effectively funded by federal government policy has inherent inefficiencies, but is something we’ve become used to.

It also is a system with massive vested interests that enjoy the power, connections and money to fight to preserve and expand those inefficiencies.

[ELVIS123456]

OK Bevup I will bite - a little.

 

Most of what you said is accurate, but is not the full story.

 

Eg.  Anyone earning over $90K PA must have private health insurance, or they will be taxed bigly.  They also still have to pay the medicare levy.  Many people earning less than $90K choose to have private insurance to avoid the Lifetime Health Cover (LHC) penalties that means the longer a person over 30 waits to take out private health insurance, the more it will cost them later.  Some people also choose to take out health insurance so that they can avoid the crowded public system, get any treatment/surgery done much quicker, and choose the doctor they want. 

 

There are many other reasons why the private health insurance exists as it does in Australia - and most of them are not the industry's fault.  Having said that, IMO the comment by the CEO of NIB was stupid.

 

[4MyEgo]

5 hours ago, ELVIS123456 said:

OK Bevup I will bite - a little.

 

Most of what you said is accurate, but is not the full story.

 

Eg.  Anyone earning over $90K PA must have private health insurance, or they will be taxed bigly.  They also still have to pay the medicare levy.  Many people earning less than $90K choose to have private insurance to avoid the Lifetime Health Cover (LHC) penalties that means the longer a person over 30 waits to take out private health insurance, the more it will cost them later.  Some people also choose to take out health insurance so that they can avoid the crowded public system, get any treatment/surgery done much quicker, and choose the doctor they want. 

 

There are many other reasons why the private health insurance exists as it does in Australia - and most of them are not the industry's fault.  Having said that, IMO the comment by the CEO of NIB was stupid.

 

Just to add to this Elvis, might be a little off the topic though.

 

If your an Xpat living here in Thailand, you are forced to take out private cover because we don't fall under a Medicare system as we did back home, and if your without private cover you are open for all sorts of problems, i.e. if you have an event, be it an emergency or an accident. 

 

A lot of blokes say that international private health cover is too expensive (I also used to say that until recently), when a mate of mine actually said, what are you talking about, you don't pay tax as a foreign resident, and your not entitled to Medicare after 5 years away from Australia, (debatable), so just look at it as if you were earning the income you were back home, with the 2% Medicare levy surcharge and the 1.5% additional surcharge after $90k, and you will see international private health cover will cost you exactly what you would have been paying into Medicare back then, eg (I was one who didn't take out private cover back in Australia), even though I was on a good salary and could have saved the additional 1.5% surcharge.

 

Now I will agree not most wouldn't have been earning what I was earning, but if one shops around for private health cover for Thailand, you usually get neighbouring countries thrown in, plus 60-90 days emergency cover for when you go back to Oz, and when you break the cost of the policy down, it works out to be about 180 baht per day for someone over 55 but under 60, that said, there are cheaper health providers around as well, it just depends on the level of cover you want, i.e. $500,000 USD or $1,000,000 USD.

 

That said, I have been told by many that as long as you keep renewing your Medicare card every 5 years, i.e. (by maintaining an Australian address), you can still claim on Medicare, I haven't been out of the country that long, but did use it successfully after 18 months absent and will be giving it another go in 18 months (this October), and have recently renewed it for another 5 years. 

 

Just saying for those here who haven't got private cover, I have done the hard yarns looking around and have a spread sheet with costs of companies and a good broker should anyone be seeking to take the next step, nothing in it for me.

 

PM me and I can send you the spreadsheet with costs, cover, etc etc and the name of the broker I use for your enquires, no hassle type broker as well.

[ELVIS123456]

9 hours ago, 4MyEgo said:

Just to add to this Elvis, might be a little off the topic though.

 

If your an Xpat living here in Thailand, you are forced to take out private cover because we don't fall under a Medicare system as we did back home, and if your without private cover you are open for all sorts of problems, i.e. if you have an event, be it an emergency or an accident. 

t 

A lot of blokes say that international private health cover is too expensive (I also used to say that until recently), when a mate of mine actually said, what are you talking about, you don't pay tax as a foreign resident, and your not entitled to Medicare after 5 years away from Australia, (debatable), so just look at it as if you were earning the income you were back home, with the 2% Medicare levy surcharge and the 1.5% additional surcharge after $90k, and you will see international private health cover will cost you exactly what you would have been paying into Medicare back then, eg (I was one who didn't take out private cover back in Australia), even though I was on a good salary and could have saved the additional 1.5% surcharge.

 

Now I will agree not most wouldn't have been earning what I was earning, but if one shops around for private health cover for Thailand, you usually get neighbouring countries thrown in, plus 60-90 days emergency cover for when you go back to Oz, and when you break the cost of the policy down, it works out to be about 180 baht per day for someone over 55 but under 60, that said, there are cheaper health providers around as well, it just depends on the level of cover you want, i.e. $500,000 USD or $1,000,000 USD.

 

That said, I have been told by many that as long as you keep renewing your Medicare card every 5 years, i.e. (by maintaining an Australian address), you can still claim on Medicare, I haven't been out of the country that long, but did use it successfully after 18 months absent and will be giving it another go in 18 months (this October), and have recently renewed it for another 5 years. 

 

Just saying for those here who haven't got private cover, I have done the hard yarns looking around and have a spread sheet with costs of companies and a good broker should anyone be seeking to take the next step, nothing in it for me.

 

PM me and I can send you the spreadsheet with costs, cover, etc etc and the name of the broker I use for your enquires, no hassle type broker as well.

All true and excellent advice 4myego.  I used to have private insurance in Aust, and was very annoyed that I still had to pay a lot whenever myself or kids needed hospital treatment. In Aust it is not 'real' insurance - like say for a car.  You can insure a car for a certain amount and if it is stolen you get that amount.  But you cant have medical insure for any 'amount'. You can only insure to cover the 'approved' medicare cost of a procedure, and for a percentage more on top of that -  which varies between hospitals/doctors and insurance companies, and what policy you take out. What does not change is that you still have to pay 'the gap' even if you/company pays $900 a month in privatre insurance. In Aust you cant insure and have no gap to pay.  That is mandated by the Fed Govt - and IMO the system if wrong.  Hey - I worked in Canberra for 25 years and they couldnt organise a p**s up in a brewery properly and anything they design/organise/manage is screwed up due to all the compewting vested interests in any Govt Program (and the general ignorance and incompetance of the public servants).   And the insurance system in Thailand is even more 'restricted', and because the insurance companies control it. They also have big ionfluence over the court system, and they know they can very much get away with anything.  So you are left with the international companies - and they are fraught with downsides and gotchas - and extremely expensive.

 

However - there is a solution - but it requires another lifesyle.  If, like me, you will be travelling between both Thailand and Australia on a regular basis, then you can get Travel Insurance to cover for a serious medical issue/accident/problem.  IMO this is 'real' insurance and what should be available in Aus - but it is not allowed by the Govt.  With Travel Insurance, from a reputable Australian insurance company/agent, you can be covered for all Hospital medical expenses up to a certain limit, in relation to any serious accident or illness - including repatriation costs back to Australia. I have done this every time I visited Thailand in the past, including when I was 'living' in Thailand, because I maintained a premises and presence in Australia.  My plan is to (eventually) spend 3-9 months of every year in Thailand, and to spend the rest in Australia - plus visits to other SE Asia countries.  Each time I leave Australia I will get Travel Insurance with the maximum medical cover option, and forgo the options like baggage coverage.  You can get it for up to 12 months at a time, and with some companies you can extend it for another 6-12  months.  Point to note is that the day you return to Aust, the policy is terminated, and once you make a claim, the policy is terminated.

 

Under this method, all of the every day medical expenses have to be 'self-funded', and you only have coverage for a serious medical problem requiring hospital attendance/treatment, and of course any pre-existing illness or injuries (and any directly related problems) are not covered. But that is what I want/need - coverage for the wife and I for a one-off serious hospital problem that could otherwise cost a small fortune to get treated in a private Hospital in Thailand.  Everything else is something I will pay for in Thailand, or make a decision whether to get it done when next back in Australia. 

 

There is another option I have been aware of, that could suit those that only live in Thailand and rarely/never travel back to Australia. Instead of paying for the extremely expensive private insurance, with absolutely no guarantee the company will pay up, you put a similar amount of money into a new and seperate bank account that you never touch. Have a monthly transfer of whatever amount go into this new account.  After 5 years you will have enough to cover many things, and after 10-12 years you will have enough for just about anything. Once you have enougn you stop adding to it and you leave it alone until you really need it. I like this option and would take it up myself if I never returned to Aust. I would put in an initial amount of about 100K baht, and then add about 10K baht a month. After 5 years I would have 700K baht, and after 10 years I would have $1.3 million baht.

 

 

 

 

 

 

 

 

[4MyEgo]

2 hours ago, ELVIS123456 said:

All true and excellent advice 4myego.  I used to have private insurance in Aust, and was very annoyed that I still had to pay a lot whenever myself or kids needed hospital treatment. In Aust it is not 'real' insurance - like say for a car.  You can insure a car for a certain amount and if it is stolen you get that amount.  But you cant have medical insure for any 'amount'. You can only insure to cover the 'approved' medicare cost of a procedure, and for a percentage more on top of that -  which varies between hospitals/doctors and insurance companies, and what policy you take out. What does not change is that you still have to pay 'the gap' even if you/company pays $900 a month in privatre insurance. In Aust you cant insure and have no gap to pay.  That is mandated by the Fed Govt - and IMO the system if wrong.  Hey - I worked in Canberra for 25 years and they couldnt organise a p**s up in a brewery properly and anything they design/organise/manage is screwed up due to all the compewting vested interests in any Govt Program (and the general ignorance and incompetance of the public servants).   And the insurance system in Thailand is even more 'restricted', and because the insurance companies control it. They also have big ionfluence over the court system, and they know they can very much get away with anything.  So you are left with the international companies - and they are fraught with downsides and gotchas - and extremely expensive.

 

However - there is a solution - but it requires another lifesyle.  If, like me, you will be travelling between both Thailand and Australia on a regular basis, then you can get Travel Insurance to cover for a serious medical issue/accident/problem.  IMO this is 'real' insurance and what should be available in Aus - but it is not allowed by the Govt.  With Travel Insurance, from a reputable Australian insurance company/agent, you can be covered for all Hospital medical expenses up to a certain limit, in relation to any serious accident or illness - including repatriation costs back to Australia. I have done this every time I visited Thailand in the past, including when I was 'living' in Thailand, because I maintained a premises and presence in Australia.  My plan is to (eventually) spend 3-9 months of every year in Thailand, and to spend the rest in Australia - plus visits to other SE Asia countries.  Each time I leave Australia I will get Travel Insurance with the maximum medical cover option, and forgo the options like baggage coverage.  You can get it for up to 12 months at a time, and with some companies you can extend it for another 6-12  months.  Point to note is that the day you return to Aust, the policy is terminated, and once you make a claim, the policy is terminated.

 

Under this method, all of the every day medical expenses have to be 'self-funded', and you only have coverage for a serious medical problem requiring hospital attendance/treatment, and of course any pre-existing illness or injuries (and any directly related problems) are not covered. But that is what I want/need - coverage for the wife and I for a one-off serious hospital problem that could otherwise cost a small fortune to get treated in a private Hospital in Thailand.  Everything else is something I will pay for in Thailand, or make a decision whether to get it done when next back in Australia. 

 

There is another option I have been aware of, that could suit those that only live in Thailand and rarely/never travel back to Australia. Instead of paying for the extremely expensive private insurance, with absolutely no guarantee the company will pay up, you put a similar amount of money into a new and seperate bank account that you never touch. Have a monthly transfer of whatever amount go into this new account.  After 5 years you will have enough to cover many things, and after 10-12 years you will have enough for just about anything. Once you have enougn you stop adding to it and you leave it alone until you really need it. I like this option and would take it up myself if I never returned to Aust. I would put in an initial amount of about 100K baht, and then add about 10K baht a month. After 5 years I would have 700K baht, and after 10 years I would have $1.3 million baht.

 

 

 

 

 

 

 

 

ELVIS123456 just a couple of quick question so I am on the same page as you.

 

Living here, while maintaining an address back in Oz and your getting travel insurance from Oz, how can that be, as my understanding is if your passport is stamped with a retirement visa or spouse visa which allows you to stay longer than the usual 2-3 month tourist visa, how would you be able to make a claim on travel insurance.

 

My understanding is that their fine print says something on the lines of, place of residency or something like that, not arguing with you on what you wrote on your post above, I think its a great idea, but isn't this a bit tricky, sure your an Australian Resident, but what is your passport stamp, if it is a retirement visa or spouse visa, I think you would have a serious problem.

 

Hopefully you have a tourist visa and extend it by exiting the country over the boarder for a couple of hours/a day or something like that, which would make your travel insurance valid, as you would be deemed a tourist, no argument there, but if it was stamped differently, I think you will find it not valid.

 

Just wanting to clarify this please.

[ELVIS123456]

3 hours ago, 4MyEgo said:

ELVIS123456 just a couple of quick question so I am on the same page as you.

 

Living here, while maintaining an address back in Oz and your getting travel insurance from Oz, how can that be, as my understanding is if your passport is stamped with a retirement visa or spouse visa which allows you to stay longer than the usual 2-3 month tourist visa, how would you be able to make a claim on travel insurance.

 

My understanding is that their fine print says something on the lines of, place of residency or something like that, not arguing with you on what you wrote on your post above, I think its a great idea, but isn't this a bit tricky, sure your an Australian Resident, but what is your passport stamp, if it is a retirement visa or spouse visa, I think you would have a serious problem.

 

Hopefully you have a tourist visa and extend it by exiting the country over the boarder for a couple of hours/a day or something like that, which would make your travel insurance valid, as you would be deemed a tourist, no argument there, but if it was stamped differently, I think you will find it not valid.

 

Just wanting to clarify this please.

Good questions - happy to answer and clarify.

 

Prior to first doing this in 2012, I rang the travel insurance company and confirmed that it didnt matter what Visa I was visiting the country on, as long as I was a citizen or permanent resident of Australia, and that I was not 'resident' in Thailand. So I was not 'living' in Thailand - I was on an extended holidasy visit to Thailand.  That they quoted me a price for 9 months insurance in Thailand, which I then extended to 12 months, shows that they know I am stayiong in Thailand for that period of time.  There are a lot of questions you must answer before getting a quote. 

 

Yes you are right - if I had 'residency' in Thailand - meaning I was no longer resident in Australia and had set up a home in Thailand - then the policy would not cover me. The fine line is that this option is opnly available to someone who truly maintains an Australian residence, and does not maintain a residence in Thailand.  If you visit Aust for a few weeks now and then, this ios not an option.  I will be living in Australia and visiting Thailand every time I travel to Thailand.  As long as that is the case, then there is no limit to how many times you can get a travel insurance policy.  

 

So unless things have changed, it doesnt matter what type of Visa you get to be able to stay in a country for 6-9 months of any year.  The key issue is that you must still live in Australia, and be visiting Thailand. 

 

But I must admit that I did only quickly read through the Ts&Cs to make sure what I was told in 2012 was true, and noting the exclusions like motorbikes and skiiing and climbing mountains and abseiling etc etc.  If/when I get the chance I will take a more detailed examination of my latest Travel Insurance policy - done in Feb/March this year.  If/when I do that I will do a follow up post.

 

 

[ELVIS123456]

I have checked out the PDS for Travel Insurance with 2 providers.  The following is noted from both company's PDS:

 

Resident of Australia means someone who currently resides in Australia and is eligible for an Australian Medicare Card.

 

Cover is only available if:  You are an Australian citizen or holder of a valid Australian permanent residency visa and are permanently residing at an Australian address, or You are a non-permanent resident who holds a valid Medicare card or are covered by an Australian Private Health Insurance policy that satisfies the government health insurance requirements for Your visa type; and  You purchase Your Policy before You commence Your Journey; and Your Journey commences and ends in Australia; and You meet the following age limits: – at the time You purchase a Comprehensive, Basic or Saver Policy You are not more than 79 years old;

 

The coverage is for an Australian Resident travelling overseas.  It does not state anywhere what types of Visa you must have.  There is nothing regarding visiting friends or relatives in the country/s concerned.  And as I was advised before, it is Travel Insurance - it is not Tourist/Visitor Insurance.

 

So if CLink says I am an Australian Resident, and ATO says I am an Australian Resident, and Immigration says I am an Australian Resident, then I doubt the insurance company can determine that I am not.  And I have recourse to the ACCC and Insurance Ombudsman and Tribunal if they should try to deny liability.  Unlike with insurance purchased in Thailand, under Thailand Laws, I would have legal recourse in the event of a payment dispute if it was needed.  

 

Price?  Alliance quoted $700 for 9 months and Hollards was about the same. I found that for whatever reason it pays to shop around well before each trip - and only after having purchased the airline tickets.  I never choose the cheapest options from unknown companies.

 

But as I said before - you must reside in Australia and be visiting Thailand. You must have a premises in Australia (either rent or own), that you live in.  That you are visiting for up to 12 months at a time is irrelevant. But I would suggest that the occasional trip for only 3-6 months would be wise.   

 

[giddyup]

On 5/31/2018 at 10:11 PM, 4MyEgo said:

 

 

That said, I have been told by many that as long as you keep renewing your Medicare card every 5 years, i.e. (by maintaining an Australian address), you can still claim on Medicare, I haven't been out of the country that long, but did use it successfully after 18 months absent and will be giving it another go in 18 months (this October), and have recently renewed it for another 5 years. 

 

Just saying for those here who haven't got private cover, I have done the hard yarns looking around and have a spread sheet with costs of companies and a good broker should anyone be seeking to take the next step, nothing in it for me.

 

PM me and I can send you the spreadsheet with costs, cover, etc etc and the name of the broker I use for your enquires, no hassle type broker as well.

I have been in Thailand over 8 years and have renewed my Medicare card twice, getting it sent to a mate's address in Australia. I have never been back in that time so haven't put it to the test as to whether I'd be covered for medical treatment if I returned, have yet to hear about anybody that has done successfully. I don't have health insurance in Thailand because being over 75 the premiums would be prohibitive, so I have to hope that my nest egg will cover any treatment I might need. I had to have my gallbladder removed recently at a private hospital which cost me just over 200,000 baht, which is affordable, but obviously any disorder that involved long term treatment would be a worry.

[4MyEgo]

14 hours ago, giddyup said:

I have been in Thailand over 8 years and have renewed my Medicare card twice, getting it sent to a mate's address in Australia. I have never been back in that time so haven't put it to the test as to whether I'd be covered for medical treatment if I returned, have yet to hear about anybody that has done successfully. I don't have health insurance in Thailand because being over 75 the premiums would be prohibitive, so I have to hope that my nest egg will cover any treatment I might need. I had to have my gallbladder removed recently at a private hospital which cost me just over 200,000 baht, which is affordable, but obviously any disorder that involved long term treatment would be a worry.

75, keep rocking young fella