Private Health Reforms - Consultation Paper 1

Overview

This is the first of a suite of consultation papers which the department will release over the coming months.

These proposals do not represent government policy. Government will decide whether to implement any changes, including potential changes to Medicare Benefit Schedule (MBS) items. The decision to create new or amend MBS items are informed by well established clinical and economic assessment processes including appropriate consideration and advice by the Medical Services Advisory Committee. 

The department encourages insurers to take the proposed reforms into consideration when developing new or amended products and premiums for the 2027 Premium Round (submissions open in September and are due in November 2026). This paper covers the following elements: 

1. Prioritising contemporary models of care including: 

• mental health care 
• maternity care 
• Hospital in the Home (HITH), and 
• Type C certification requirements: exemption criteria.

2. Delivering better value for consumers through:  

• improving access to regional private hospitals  
• Private Health Insurance product simplification, and  
• updating Risk Equalisation. 

Why your views matter

The department anticipates that the primary audience for this consultation will include insurers, private hospitals, health professionals, consumers/patients and their advocates, medical device companies and jurisdictional government agencies. 

The department will use feedback received through this consultation process to inform advice to government for consideration.