PHI Complaints Down by 29 per cent

16 Feb 2017Media Releases

The latest statistics from the Private Health Insurance Ombudsman show a significant drop in the number of consumer complaints regarding PHI.

Private Healthcare Australia Chief Executive Dr Rachel David said this supported recent research showing that 84 per cent of health fund members value their PHI because it gives them security and confidence they can access medical treatment when and where they need it. (IPSOS)

Complaints to the Ombudsman during the December 2016 quarter were down by 29% on the previous September 2016 quarter. The majority of the complaints pertained to IT issues that have since been addressed. The Ombudsman received 1504 complaints regarding health insurance in the September quarter dropping to 1067 complaints in the December quarter.

The PHIO quarterly report also addressed complaints received as part of the recent Australian Dental Association Campaign. The ADA provided an online complaint form which automatically sent complaints to PHIO’s email address and contacted its members to encourage them to complete the form.

The PHIO report states: “Health insurance for dental services in Australia are not specially regulated by the Government. Therefore the level of benefits and provision of dental centres and preferred provider schemes are the result of market forces and the decisions of consumers to choose policies with such benefits”.

PHIO did not record complaints initiated via the ADA campaign as part of its usual procedures as “they are different from matters PHIO considers in its normal complaint handling, where we consider an individual complaint and raise it with an insurer for a response”. (PHIO)

In addition PHIO has clarified incorrect reports that over 40,000 policies are available to consumers in the Australian health insurance market. PHIO produced two case studies showing that, by removing policies that are no longer available for purchase and those only available to people meeting certain criteria (e.g. employees of a particular company or ex-military personnel), the total number of PHI policies to choose from is significantly lower. PHIO found that for a single person living in Victoria there were only 185 available PHI policies in the market, while for a family living in Western Australia there were 230 available policies.

Dr David said the latest Government statistics show that 13.5 million Australians have some form of private health insurance. They are hard-working Australians who value their private health cover and their right to choose when and where they have medical care.

“Health funds are making a considerable investment in work to help consumers navigate a complex system, including making it easier to choose health fund products based on cost and need,” she said.


Media contact: Jen Eddy 0439 240 755