Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Hansard source

Prior to Medicare, medical bills were the major cause of bankruptcies in Australia. That ended overnight. It's worth noting that medical bills are still a major cause of bankruptcies in the US, and consequently Americans choose to avoid seeking health care or seeking a diagnosis. They fear the costs pushing them into bankruptcy and homelessness. That's why the US health system is the most expensive in the modern world and has the worst results at a population level. This is not what we want for Australia and for Australians. Despite its challenges, Australia's health system is the best in the world. If you are sick or injured, you wouldn't want to be anywhere else.

We know that those opposite oppose Medicare. The shadow Treasurer has said that we should get rid of Medicare and instead have individual accounts that we can draw down on when we need care, which of course would be a disaster for those who are particularly unwell. If you had a lifelong condition, a chronic disease, a cancer diagnosis, a catastrophic injury or a progressive disease, your account would run dry.

Despite the benefits of Medicare in making Australian health care affordable as a blended public-private system, gap fees do accrue to patients, and constituents contact me about having to pay an unexpected gap fee or even the entirety of the cost of a GP referred specialist appointment. Health care should not be a financial risk in this country. It shouldn't require hedging your bets when your health is at stake.

More than half of Australians are on some form of private health insurance. Private health is crucial to the sustainability of Australia's broader health system, helping in particular to alleviate an already overburdened public health sector. Yet we all know that private health premiums are rising year on year. Patients deserve peace of mind, knowing that the cost of the care they're receiving is being paid with the full knowledge of their options—peace of mind that they don't need to worry about money in the midst of a serious health crisis, peace of mind that they can seek screening tests or diagnosis without having to worry about unexpected bills. We want Australians to seek diagnosis and early intervention for their own best health outcomes and also to manage costs in the health system by keeping them out of hospital where possible. In this country, equitable health access is a right, not a privilege, no matter whether you're paying for it via private health or Medicare, and that is why the Albanese Labor government is committed to delivering a private health insurance framework that is fair, efficient and accessible.

The Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 seeks to course-correct longstanding deficits in the private health system. It seeks to enshrine private health consumers' rights and their ability to be the masters of their own health destiny. It does so in two ways. Firstly, it ensures that Australians are able to make an informed choice about the cost of specialist medical advice and treatment through improvements to the Medical Costs Finder tool. Secondly, it ensures that price gouging by private health insurers by way of product phoenixing is curbed. As a result, private health consumers can be confident that the cost of their medical service is market standard. The bill ensures that Australians are able to access detailed information about the costs and associated costs of their medical specialist appointment and treatments.

The Australian Bureau of Statistics reports that the cost of medical and hospital services has contributed to health inflation more generally, with flow-on effects for the out-of-pocket costs and higher insurance premiums. The most common cause of out-of-pocket costs are medical specialist fees. The typical out-of-pocket cost for a specialist procedure in Australia is $1,000. Unsurprisingly, this has seen patients refuse to take up a specialist referral from their GP owing to their fears of the potential costs, which are often unknown and unpredictable. In the financial year 2024-25, 8.6 per cent of patients delayed or missed specialist care, citing cost factors—that is, over 800,000 people. One in two patients don't know what their bill is going to be before an appointment; 38 per cent received an unexpected bill.

The proposed legislative arrangement follows Labor's 2025 election commitment and the 2025-26 budget measure to improve transparency in medical pricing information in order that Australians are able to make informed and knowledgeable decisions about their healthcare needs. Because patients shouldn't be slapped with a bill without the full knowledge of what they're paying for, how much they should be paying, and having the opportunity to compare other medical providers. Additionally, knowing what private health insurers are prepared to cover will help consumers determine their out-of-pocket costs.

The former coalition government previously invested $22 million in the Medical Costs Finder website, which is informed by data from Medicare and from the information volunteered by Medicare medical practitioners. By the end of 2022, of the 6,300 medical practitioners registered to practice in the 11 specialities included in Medical Costs Finder, only six decided to voluntarily offer up their pricing information. Three years later, only 88 doctors have signed up. As at December 2025, that's maybe one to two per cent of specialists and 10 per cent of insurers who decided to participate in the Medical Costs Finder.

The problem with the former government's voluntary model, as the president of the AMA, Dr Danielle McMullen describes it, is that private health insurers were extremely reluctant to upload their information, which also created a significant disincentive for doctors to upload their own billing data. Indeed, she continues:

The AMA has pushed hard for Medicare rebates and insurer benefits to be included on the Medical Costs Finder, so that patients get the full picture of why they may face an out-of-pocket cost …

Access to insurer data is crucial for patients, alongside clear information on Medicare rebates, which have failed to keep pace with inflation for decades and remain a major driver of out-of-pocket costs. The amendment will allow the Medical Costs Finder website to publish individual medical practitioner and insurer out-of-pocket costs for common medical services, but medical practitioners, including specialists and GPs, will no longer be required to volunteer their own billing information. Instead, it will be taken from Medicare, hospitals and insurer billing data already collected by the government

Specifically, the bill will amend the Health Insurance Act 1973 and the Private Health Insurance Act 2007 to allow for the publication of information about medical practitioners and their billing, including names; qualifications; speciality; any languages spoken; fees charged by location; and their utilisation of gap cover arrangements with insurers, where insurers pay a medical practitioner more if they agree to charge no or fixed out-of-pocket costs. The bill will allow for the publication of information about health facilities such as hospitals, including information about medical practitioners who provide services at the facility and insurers that have gap cover or contracting arrangements with the facility, and will allow for the publication of information about insurers, including policy holders who experience different gap cover arrangements and the out-of-pocket costs under those gap cover arrangements.

We all know that specialist fees vary drastically across the country and even within individual communities. These changes to the Medical Costs Finder will provide patients and consumers with efficient and at-hand access to detailed pricing information in order that they can compare costs and make the right decision for themselves. The ability—the right—to shop around is crucial to the private health marketplace. In fact, the visibility and transparency of medical pricing will reinforce a standard among medical practitioners and insurers that is in keeping not only with market expectations but also with community expectations.

The bill also outlaws a widespread practice among private health insurers called product phoenixing. Health insurers are required to limit price rises to a percentage approved by the Minister for Health and Ageing on an annual basis. Some health insurers have been employing what the Commonwealth Ombudsman has dubbed a 'loophole tactic', a deliberate and cynical strategy to get around this price increase limitation. Product phoenixing is when a private health insurer closes an existing product and then reopens an identical product at a higher premium, skirting regulatory oversight and ministerial scrutiny.

Despite being warned by the minister for health, private health insurers have continued this deceptive practice. Indeed, an investigation by consumer group CHOICE found that the price of gold-tier policies increased on average by more than 30 per cent over a three-year period. This kind of price gouging is not only amoral and unethical; it should be illegal. As the president of the AMA has stated:

Private health insurance premiums have outpaced wages and inflation in recent years, all while insurers' management expenses and profits continue to soar … The widespread practice of phoenixing is a major factor in consumers struggling to access the level of cover that meets their needs, and it is eroding public confidence in the private health system.

So the minister for health has acted to eliminate this specific practice. This amendment will restore consumer confidence in the private health system. Current arrangements oblige private health insurers to seek the minister for health's approval for change to the premium of an existing product, which is managed administratively during the annual premium round process. The proposed amendment would require that approval would additionally need to be sought from the Minister for Health and Ageing where a new product is being proposed or where mooted changes will reduce cover, a benefit, or a term or conditions of an existing product.

The amendment will also improve and enhance current arrangements for premium approvals, including creating in legislation specific premium round submission dates and an instrument that will allow the minister to vary those dates; creating a stronger public interest test for submissions outside the premium round to compel more applications within the approved period; creating a power for the minister to delegate approval authority, which is likely to be used in the instances of more straightforward applications that are clearly in the public interest; creating a legislative basis on which the minister can request further information about an application and request that the insurer respond, resubmit or further justify their application; and creating a rule-making power to set a fee for insurer applications for premium approval. By banning product phoenixing and streamlining the premium approvals process, consumers can be confident that they will not be shortchanged on their policy because of private health insurers underhanded and unethical getting around of government regulatory oversight.

The Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 will ensure that the private health experience of patients is fair, reliable and accessible. The bill is about enforcing a culture of transparency across the private healthcare landscape, prioritising, in the first instance, the individual patient's right to access the full suite of medical information, including costs, not after but prior to their specialist appointment and treatments. It will clamp down on the backroom practices of private health insurers who seek to make a profit off the health anxieties of their consumers. Fundamentally, this bill is about guaranteeing better health outcomes for all patients, it is about modernising and improving private health provision across this country, it's about embedding a culture of fairness and transparency in the private health marketplace, and it's about ensuring that Australians have, as a basic expectation, financial certainty during a time of great uncertainty as they battle with illness and disease.

Having worked in the sector for a couple of decades, I know how important our health system underpinned by Medicare is to the quality of life we enjoy as Australians. This government is acting to ensure that the health system continues to support the health of Australians. I commend the bill to the House.

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