Australia

The Australian government in contrast to the New Zealand government, has intervened in the Australian private health insurance industry, both in regulating its processes and in incentivising greater uptake of insurance (Colombo & Tapay, 2003). The regulations imposed on the industry have largely been in place since 1953 and are beyond the scope of this project (Colombo & Tapay, 2003).

The institutional arrangement of interest is the Private Health Insurance Incentives Scheme, which involved three stages over the period of 1997 – 2000, over which time private health insurance coverage jumped from 30.1% to 46% of the population (Harley et al., 2002). Three stages to the scheme:

  1. 1997: Tax penalty on high earners who did not have private health insurance, in addition to a 30% subsidy on premiums for people on low incomes
  2. 1998: 30% subsidy was made universal (no longer means-tested)
  3. 2000: This change related to a pre-existing regulation, and was beyond the scope of this project.

The results of in-depth case study on the first two measures are presented in the below table:

Incentive

Assessment

Tax penalty for high earners without insurance
  • Introduced greater equity into the system; high earners who could reasonably afford private health insurance, then had to contribute toward some of the cost of their health care use
  • Did little to increase uptake of insurance, but raised additional funds, so neutral on efficiency
  • Additional administrative complexity in changes to tax system
Universal 30% rebate on premiums
  • Equity: questionable in that created greater equity of access, but those who had to continue using the public system were in essence subsidising the insured
  • Represented poor efficiency as came with a large public price tag, but did not increase coverage at the rates hoped
  • Complex to administrate as multiple ways to receive subsidy

 

Colombo, F. & Tapay, N. (2003). Private health insurance in Australia: A case study. OECD health working papers no. 8. Retrieved from http://www.oecd.org/dataoecd/5/54/22364106.pdf

Harley, J., Vaithianathan, R., Crossley, T. F., Cobb-Clark, D. (2002). Parallel Private Health Insurance in Australia: A Cautionary Tale and Lessons for Canada. Retrieved from ftp://repec.iza.org/RePEc/Discussionpaper/dp515.pdf