Monique Ryan (Kooyong, Independent) | Link to this | Hansard source

by leave—I move amendments (1) to (6), circulated in my name, together:

(1) Schedule 1, item 1, page 4 (after line 11), after paragraph 124ZY(2)(b), insert:

(ba) information about amounts of medical expenses incurred in respect of particular kinds of professional services, including median and interquartile ranges for particular kinds of professional services;

(bc) information about amounts of medical expenses incurred in respect of particular kinds of professional services that exceed the high fee threshold for those kinds of professional services;

(2) Schedule 1, item 1, page 4 (line 21), at the end of subsection 124ZY(2), add:

; (e) quality indicators such as complications rates, re-admissions and patient-reported outcomes for particular medical professionals;

(f) information on professional services rendered by or on behalf of particular medical practitioners that incur upfront fees;

(g) information on professional services rendered by or on behalf of particular medical practitioners that utilise gap cover arrangements.

(3) Schedule 1, item 1, page 4 (after line 21), after subsection 124ZY(2), insert:

(2A) The Minister must publish any formula used to work out an amount of medical expenses for the purposes of publication under this section.

(2B) If the Minister publishes information about medical expenses in respect of particular kinds of professional services rendered by or on behalf of particular medical practitioners, and the Minister becomes aware of a material reduction in those expenses, the Minister must update the published information as soon as practicable after becoming so aware.

(4) Schedule 1, item 1, page 4 (after line 36), after subsection 124ZY(6), insert:

(6A) The Minister must, by legislative instrument, determine formulas for working out amounts of medical expenses in relation to particular kinds of professional services.

(6B) The amount worked out in relation to a particular kind of professional service, in accordance with a formula determined under subsection (6A), is the high fee threshold for that kind of professional service.

(5) Schedule 1, item 1, page 5 (after line 19), after section 124ZZA, insert:

124ZZB Annual report

(1) As soon as practicable after the end of each financial year beginning after the commencement of this section, the Secretary must publish a report about trends identified in the information published under section 124ZY.

(2) Such trends may include:

(a) movements in median price ranges in respect of particular kinds of professional services; and

(b) geographical variation.

(3) The Minister must table the report in each House of the Parliament no later than 6 months after the end of the financial year.

(6) Schedule 2, item 8, page 26 (after line 26), after section 66-12, insert:

66-13 Annual audit of product phoenixing practices

(1) The Minister must cause a review of private health insurance product changes during each financial year beginning after the commencement of this section to be conducted as soon as practicable after the end of the financial year.

(2) The review must consider:

(a) each application made in the financial year in respect of a *product subgroup under section 66-8; and

(b) each application made in the financial year in respect of an insurance premium under 66-10; and

(c) each designated change to a *complying health insurance product in the financial year; and

(d) the number of cases where product phoenixing behaviour was identified in the financial year; and

(e) any issues or recommendations.

(3) The Minister must table the report in each House of the Parliament no later than 6 months after the end of the financial year.

Australians deserve clear, accessible information about the true costs and quality of medical care. For much too long, we've been forced to navigate a system in which price signals have been opaque and quality indicators virtually invisible. These amendments will strengthen the government's bill such that patients and practitioners have meaningful transparency, information asymmetry is reduced and we can potentially create downward pressure on specialist fees.

Firstly, amendment 1 explicitly allows the publication of median fees, interquartile ranges and information on fees that exceed a new high-fee threshold. Patients need to know more than just an average single fee. That's what the government is proposing under this legislation. Patients need to know what a physician's or surgeon's typical costs look like, but they also need to be able to identify those doctors who bill a lot more than their peers. Publishing distributional price information will help patients recognise unusually high fees and compare specialist fees more readily—and, in time, could shift demand away from those outliers who bill excessively.

Amendment 2 broadens the information that may be published under this bill to include quality indicators, things like complication rates, readmissions, repeat procedures and patient reported outcomes. Many people innocently assume that, when it comes to medicine or even the law, higher fees signal higher quality. But the evidence—and my experience as a doctor—does not support that assumption. The quality of specialist service varies, sometimes significantly, but not in the way that fee structures imply. Publishing quality indicators will empower patients to choose medical practitioners on their merits, and it provides the system with an important signal: quality matters just as much—in fact, even more than—fees. Amendment 2 also enables the publication of information about practitioners who charge upfront fees or who rely on gap cover arrangements. These can be key drivers of unexpected out-of-pocket costs.

Next, access to timely data matters. If a specialist materially reduces their fees, the Medical Costs Finder should reflect that. Amendment 3 ensures that doctors who lower their fees will not be punished by outdated, high, historical figures presented as their fees of record. Amendment 3 will create a culture in which specialists can be confident about adjusting fees downward, knowing that the system will recognise, reflect and reward those actions.

The legislative objective of this bill centres on transparency. In my view, the bill must not allow fee figures or the high-fee threshold to be determined behind closed doors. Amendment 4, therefore, requires the minister to publish, through legislative instrument, the method used to calculate those figures. The medical sector should be able to see, to understand and, where necessary, to scrutinise how the system assigns a fee against the services that they deliver. An opaque methodology would undermine trust, and it would contradict the transparency that this legislation is designed to deliver.

Finally, transparency is meaningful only if its effects are monitored, and amendment 5 introduces an annual reporting requirement on trends identified in pricing and billing data. This would enable a parliament to monitor whether or not this legislation is working, whether specialist fees are moderating and whether the millions of Australians who access specialist care every year are actually and genuinely benefiting from the information that will be available to them as a result of this legislation. By embedding these amendments in the primary legislation, we will give those millions of patients greater certainty. Together, these amendments strengthen the bill's legislated objective of empowering consumers, of improving transparency and fairness and of restoring confidence in a private health system that has to work for patients, not against them.

Mark Butler (Hindmarsh, Australian Labor Party, Deputy Leader of the House) | Link to this | Hansard source

I thank the member for Kooyong for her contribution to this debate generally and for her amendments. I know the amendments moved by the member for Kooyong are grounded in a great degree of goodwill, common purpose with the government about what we're seeking to achieve here and deep experience through her time as a paediatric neurologist. We're not supporting these amendments, not because we don't share the intentions of the member for Kooyong but because we have a different approach. What we're seeking to do here is pass legislation that enables us to set up the Medical Costs Finder as a mandatory system, if you like. But, for implementation, the finer detail about how this is designed and populated is to be the subject of ongoing engagement with stakeholders. I think I indicated that a little while ago.

I note that the member's proposed amendments support the publication of different types of specific information, including fee ranges, extreme fees, quality metrics, upfront fees and some of the things the member just canvassed in her contribution. I can assure her and other members that my department is engaging with stakeholders on the design and the implementation of the changes that are enabled through this bill. That consultation process, in our view, is the appropriate mechanism to work through the details that the member for Kooyong has canvassed in her amendment.

On extreme fees, my department is working with patients, doctors and the private health sector to develop practical reform options that will improve how Australians access, navigate and afford specialist care. That includes exploring options that address concerns over the very high fees charged by some specialists. I think the member called them outliers—a description I've used, as well—compared to their peers. We see a slightly different trend out there compared to GPs, where the band of gap fees being charged is relatively consistent across the country, but there really is a wild variability at the edges of fees being charged by non-GP specialists.

On upfront fees, we agree that administrative fees, booking fees and split billing does negatively affect patients and also often leads to bill shock. Separate work is underway on this issue to explore options that strengthen informed financial consent for consumers in this respect. On the utilisation of gap cover arrangements, this bill already addresses this under proposed section 324-5, subsection (2)(e), of the Private Health Insurance Act. On frequency of data updates, we agree that it is important for users to see up-to-date data to help guide their decisions about seeking specialist care. My department intends to make frequent updates and will refresh as regularly as data availability and quality will allow.

I again want to thank the member for her support for this government's broad effort to improve choice and transparency for private health consumers. As I said, this is something where we're engaging with a range of stakeholders, including doctor representatives through the AMA and others, to make sure we get this detail right. I think we would find value in the member being engaged in that process, as well, so if she's interested I'd be more than happy to continue to engage her with that. But we are not in a position to support the amendments moved by the member for Kooyong.

Scott Buchholz (Wright, Liberal Party) | Link to this | Hansard source

The question is that the amendments moved by the member for Kooyong be agreed to.

Mark Butler (Hindmarsh, Australian Labor Party, Deputy Leader of the House) | Link to this | Hansard source

I present a supplementary explanatory memorandum to the bill. I seek leave of the House to move government amendments (1) to (9) as circulated together.

Leave granted.

I move:

(1) Clause 2, page 2 (table item 3, column 2), omit "1 April 2026", substitute "18 September 2026".

(2) Schedule 2, item 8, page 19 (lines 4 to 7), omit paragraphs 66-6(1)(a) and (b), substitute:

(a) if the Minister has not determined a period for a year under subsection (2)—the period of 55 days beginning on the third Friday in September of that year; or

(b) if the Minister has determined one or more periods for a year under subsection (2)—that period or those periods.

(3) Schedule 2, item 8, page 19 (lines 11 to 13), omit the note.

(4) Schedule 2, item 8, page 19 (after line 13), after subsection 66-6(2), insert:

(2A) Without limiting subsection 33(3A) of the Acts Interpretation Act 1901, a determination under subsection (2) of this section may be expressed to apply in relation to a specified class of application. Such a determination does not affect the operation of paragraph (1)(a) of this section in relation to other classes of application.

(5) Schedule 2, item 8, page 19 (line 17), before "A designated change", insert "(1)".

(6) Schedule 2, item 8, page 19 (line 19), before "a change", insert "subject to subsection (2),".

(7) Schedule 2, item 8, page 19 (after line 34), at the end of section 66-7, add:

(2) The Private Health Insurance (Product Premium) Rules may provide that paragraph (1)(a) does not apply in relation to a change of a kind specified in those Rules for the purposes of this subsection.

(8) Schedule 2, items 15 and 16, page 28 (line 8) to page 29 (line 11), omit the items, substitute:

15 Application of amendments

Application provisions

(1) The amendments of sections 66-1 and 66-5 of the Private Health Insurance Act 2007 made by this Schedule apply on and after the commencement day in relation to:

(a) a policy that belongs to a product subgroup that is first made available on or after the commencement day; and

(b) a complying health insurance policy that belongs to a product subgroup of a complying health insurance product for which an approval under section 66-10 of the old Act was in effect immediately before the commencement day; and

(c) a policy:

(i) that belongs to a product subgroup that was first made available before the commencement day; and

(ii) for which there was no approval in effect under section 66-10 of the old Act immediately before the commencement day;

at and after the earlier of:

(iii) the first time, on or after the commencement day, that the premiums charged under the product subgroup change; or

(iv) the first time, on or after 2 April 2027, that a designated change is made to the product.

(2) Section 66-8 of the Private Health Insurance Act 2007, as inserted by this Schedule, applies in relation to a product subgroup that is first made available on or after the commencement day.

(3) Section 66-10 of the Private Health Insurance Act 2007, as substituted by this Schedule, applies in relation to:

(a) a proposed change to the premiums to be charged under one or more product subgroups of a complying health insurance product if an insurer proposes to make the change on or after the commencement day (whether or not the insurer proposes to make a designated change at the same time); and

(b) a designated change that an insurer proposes to make to a complying health insurance product on or after 2 April 2027.

(4) Sections 66-11 and 66-12 of the Private Health Insurance Act 2007, as inserted by this Schedule, apply in relation to an application that is made on or after the commencement day.

Pending applications for approval

(5) If:

(a) before the commencement day, a private health insurer applied, under section 66-10 of the old Act, for an approval of a change in premiums; and

(b) immediately before the commencement day, the Minister had not decided to either approve or refuse to approve the proposed changed amount or amounts;

then:

(c) the application lapses at the start of the commencement day; and

(d) that section ceases to apply in relation to the application.

Operation of first approved application period

(6) If the commencement day is a day in the period, for the 2026 calendar year, mentioned in paragraph 66-6(1)(a) of the Private Health Insurance Act 2007, as inserted by this Schedule, the approved application period for 2026 is taken to:

(a) begin on the commencement day; and

(b) end at the end of the period of 55 days beginning on 18 September 2026.

(7) The approved application period mentioned in subitem (6) does not apply to an application that relates to a designated change that is proposed to be made on or after 2 April 2027 (whether or not the application also relates to a change in premiums).

(9) Schedule 2, item 17, page 29 (line 13), omit "Section", substitute "Subject to item 15, section".

The government amendments to the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 make minor changes to the commencement date and the application of new private health insurance premium requirements to address stakeholder concerns and some implementation risks. The amendments align commencement with the start of the next premium round and give a transition period for private health insurance product changes that require premium approval. This addresses stakeholder concerns around the uncertainty of the eventual date of royal assent and how this would interact with the coming premium round. New products and price changes still require approval under the new provisions from commencement, ensuring they are included in this year's premium round intended to start mid-September 2026 with a 1 April 2027 effective date.

Amendments (5) to (7) also respond to stakeholder feedback. Insurers have argued that changes to treatment cover that arise from decisions of government or other organisations should not be treated as designated changes that require premium approval. This is because not all changes that impact treatment cover are decisions of insurers. Some are decisions of government—for example, changes to the Medicare Benefits Schedule—or of other organisations, for example the schedule of treatments that are published by the Australian Dental Association. Without this amendment, insurers would have to apply for approval, and the department of health would have to assess and approve applications that would cause unnecessary administrative burden and would not meaningfully address the objects of the bill.

These amendments therefore provide that rules may be made to exempt specified changes that reduce or remove treatment cover from being a designated change. Not all insurer requested exemptions will be appropriate. Appropriate exemptions applied through delegated legislation will allow responsive management. I thank the sector for their constructive engagement through this process and commend the amendments to the House.

Question agreed to.

Bill, as amended, agreed to.