Allegra Spender (Wentworth, Independent) Share this | Hansard source

I rise to support the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026. One of the things Australians are most proud of is our healthcare system. We value a system that ensures everyone can access the care they need through Medicare, through bulk-billing and through a network of high-quality public hospitals delivering world-class treatment. But Australia has many other aspects to its incredible Medicare system, and this bill deals with two that are of critical importance—the private health insurance part of the healthcare system, and our specialists.

Private health insurance is a crucial part of our system and of our balance. It works alongside Medicare to give people greater choice, to relieve pressure on the public system and to ensure that we can sustain a mixed model of care into the future. When it is working well, it supports timely access to treatment, greater flexibility and choice for patients, and better outcomes across the system as a whole. But, for that to remain true, Australians need to have confidence in it—confidence that it is transparent, that it offers real value and that it is supporting, not undermining, the broader healthcare system.

On specialists, I'm delighted that in Wentworth we have some of the best specialists and healthcare providers in the country. But increasingly I hear from constituents that while care is available from specialists it's not always accessible, because costs are unclear, unpredictable and sometimes unaffordable. In a cost-of-living crisis, this matters to people. It can be the difference between accessing care and choosing not to book an appointment, or it can have a tangible impact on daily decisions about spending and family accounting. This matters. While for some a referral to a specialist may be urgent, for others it may be preventive. If the price is prohibitive, this may discourage patients from accessing the preventive care tests and treatment they may need. This can have significant impacts on their health months, years or decades down the line. This is one of the core problems this bill seeks to address.

Right now, a patient will often go to their GP, receive a referral to a particular specialist and simply assume that it is appropriate or the only option, but what they are not told—and often can't easily find out—is how that specialist's fees compare to others. Right now, a patient will often go to their GP, receive a referral to a particular specialist and simply assume that it is appropriate or the only option, but what they are not told—and often can't easily find out—is how that specialist's fees compare to others. Many patients feel uncomfortable raising costs with their GP, even where there is strong trust. They may hesitate to speak openly about their financial situation or worry that asking about fees could be questioning a referral to a high-quality specialist. Two specialists with similar qualifications, experience and expertise can charge very different fees. There are often valid reasons for that, but it is not fair that patients making decisions about their health care don't have access to that information.

Health care is one of the most important decisions a person will make, yet, unlike almost every other part of our economy, we do not equip consumers with the tools to compare price, understand value and make informed choices. We know the consequences of that. In 2024-25, around 8.6 per cent of Australians, more than 800,000 people, delayed or missed specialist care because of cost. That is not just a statistic; that is people putting off essential care because they do not know how much it will cost them. This bill begins to change that.

Now to what this bill does. Schedule 1 introduces a transparency-by-default model. It amends the Health Insurance Act and Private Health Insurance Act to allow the department to publish clear comparable information on medical fees and expected out-of-pocket costs. Crucially, this information will no longer rely on voluntary participation. It will be drawn from existing databases—Medicare claims, hospital data and insurer billing data—and brought together to give consumers a clearer picture of the cost of their care. This means patients will be able to see in one place what different specialists charge for the same service, the likely out-of-pocket costs after Medicare and insurance, whether a doctor participates in gap-cover arrangements and where services are provided. It also enables publication of information about hospitals and insurers, including what policies cover, how gap arrangements work and how often patients face out-of-pocket costs. Importantly, this is done without publishing any patient information, so privacy is protected.

I'm glad this process will be done without requiring specialists to manually provide this information, instead using existing data. However, it is important that we continue to hear feedback from specialists as this process evolves to ensure that there's a smooth transition and that the data that is collected is actually an accurate representation of what is being offered to the patients. This reform will breathe new life into the Medical Costs Finder. We know that the current model hasn't worked. Despite a $24 million investment, only around one to two per cent of specialists have opted in to share their fees. This bill fixes that by making transparency systemic not optional.

I'm also supportive of the member for Kooyong's amendments, one of which seeks to use future data drawn from Medicare to provide upfront information about quality indicators—such as complication rates, readmission and patient reported outcomes—and information about whether procedures or specialists typically employ upfront or gap-cover arrangements. However, I believe this framework should only be available for the secretary to use when appropriate and alongside publication of relevant case complexity where relevant. This will ensure that it doesn't inadvertently discourage specialists from taking on more complex cases, which may carry higher readmission or complication rates regardless of the quality of care provided. This provides further information to consumers to better understand pricing arrangements and transparency regarding differences in prices, as higher prices do not always indicate higher quality outcomes. I'm also supportive of an amendment from the member for Kooyong which will ensure that the minister must update published information as soon as practicable if they become aware of a greater than 10 per cent reduction in the price of services over a three-month period.

Schedule 2 addresses another critical issue, the cost of private health insurance itself. Private health insurance covers more than 15 million Australians and represents a $30 billion industry but has also become increasingly complex and, in many cases, more expensive. One of the key issues has been product phoenixing, where insurers close an existing product and reopen a near-identical one at a higher price, avoiding the usual premium approval process. This bill closes that loophole. It requires insurers to seek ministerial approval not just for premium increases on existing products but also for new products and for changes that reduce coverage or value. It also formalises a premium approval process in legislation, introduces a clear application period and applies a public interest test to ensure the premium decisions are made with consumers in mind.

I appreciate that this is a good solution to solve a very difficult problem. I appreciate that there will be a public interest test for premium approval for new applications made by insurers within an approved application period and that there will be an allowance for the minister to delegate approval decisions but not refusal decisions. However, as is often the case when new regulatory requirements are introduced, I'll be watching closely to ensure that this does not slow down insurers' ability to bring new products and benefits to the markets.

We do not currently see from the government strong accountability when it comes to decision-making timelines. We do not see it from the government, from departments, from government agencies or from regulators, and that matters here. I do not have faith that we will see it in these instances, despite best intentions. That is why I am moving a second reading amendment in my name to address this. I move:

That all words after "not" be omitted with a view to substituting the following words:

"declining to give the bill a second reading, the House:

(1) acknowledges that while the bill introduces important measures to improve transparency and accountability in the private health insurance system, these reforms rely on decisions made by the Minister or a delegated authority;

(2) notes the Government, regulators and agencies have not consistently demonstrated strong accountability in decision-making timeframes in recent years, including in areas such as environmental approvals and delays within the Administrative Review Tribunal;

(3) recognises that delays in the approval or refusal of new or amended insurance products risk slowing the intended benefits of new products and may ultimately disadvantage Australians; and

(4) calls on the Government to:

(a) establish and enforce clear timeframes within Schedule 2 of this legislation for decisions on new product applications from insurers, and to adhere to those timeframes in practice; and

(b) establish and enforce clear timeframes across other government departments, regulators, and agencies to ensure that decisions are made in a timely way to allow businesses and Australians greater certainty of timeframe on government decisions".

I really want to make the point that delays in approvals are not just administrative; they have real consequences. They can limit access to new or improved cover, reduce choice and ultimately disadvantage patients. So, while I support stronger oversight, it must be matched with timely, efficient decision-making, because, at the end of the day, when the system slows down, it is consumers who bear the costs.

I want to talk more broadly, particularly about my second reading amendment and about government timeframes for making decisions. This is an issue I see time and time again when I talk to members of my community and when I talk to businesses in my community. I see this when I talk to businesses trying to make large investment decisions. They approach the ATO about making sure that their investment decision is being covered in a particular way, and the ATO just doesn't get back to them, sometimes for 18 months or for two years. You can't run a business like that. I see this where people are applying for visas and where family members or businesses are trying to sponsor people to come to Australia. The timeframes are indicative of what the government would like to see, but, actually, they just aren't borne out by reality. That's not a fair way to deal with people. I see this in waiting times, sometimes for things like Services Australia. I see this in home-care packages where people are promised a home-care package and then don't get it delivered for a long period of time.

I see this in an area of government that drives me crazy, which is drones. I'm going to digress here because it's really important. Drones are a capability for the future, and, when we look at what is going on in the wars overseas right now, we need to recognise that drones are probably one of the most important defence capabilities we have. But we have in this country a system where approvals of innovative drones are really slow. That is not good enough.

The government—agencies and regulators—are not accountable for the timeframes of their decisions. Government is a monopoly. Government agencies and regulators are monopoly providers of services. They do not hold themselves accountable to businesses or consumers who rely on timely decisions and who often are afraid to push for more timely decisions, because they're scared that they're going to get a negative outcome. That is why putting everything back in the hands of the minister makes me nervous. What is the commitment of the minister to make timely decisions? What is the commitment of the government to ensure that this doesn't just slow down new products being offered to Australian consumers who need them?

To return to the key part of the bill, however, I do support the intention of the bill, which is that of practical reforms that will improve transparency, strengthen oversight and help restore confidence in the private health system. I just wish that this bill included something that committed the government to a timeframe in which to do its work. It is important that this oversight remains and that transparency remains. Again, I'm supportive of the member for Kooyong's amendment, which requires the minister to, after each financial year, call a review of applications for new product subgroups and changes made on premiums in order to keep parliamentary oversight of harmful private insurance practices front and centre.

But we should also be clear that this is not the end of the reform task. Transparency is essential, but transparency alone does not guarantee affordability. We still need to address the underlying drivers of rising healthcare costs. We need to ensure that rebates, gap arrangements and incentives are aligned with high-quality, accessible care and investment in prevention, and we need to ensure that private health insurance is delivering real value to Australians.

This bill lays some important foundations. It ensures that patients are no longer navigating the system in the dark and that they are equipped with more of the information they need to make informed decisions about their care. That is a fundamental principle of a fair and effective healthcare system. So, for those reasons, I commend this bill to the House.

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