The next 5 to 10 years are set to bring significant reform to the wider health sector and will have major implications on private health insurance (PHI), requiring funds to be prudentially sound, with strong risk management practices at their core.

We have deep experience operating in highly regulated industries with complex reporting requirements. That’s why we audit more PHIs than any other audit firm.

The private health insurer of the future will be an organisation whose focus is centred on the member and their experiences, an enterprise that is engaged in data analysis and leveraging emerging technologies to better understand the membership base and keeping up with trends in health care; a fund that is open to partnering with likeminded organisations and flexible in the nature of these relationships and service offerings.

CONTACT Darren Scammell

Partner - Audit & Assurance

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Risk & Regulation

With Private Health Insurers becoming APRA regulated, It is essential they adopt financial institution style risk management & governance style frameworks.

Dynamic pricing

While still promoting the non-discrimination of any person to join a health fund, the increased use of data from multiple sources will assist health insurers in improved pricing of the risk to members.

Government reform

The Australian health care sector has undergone and will continue to undergo, significant reforms. With an increasingly ageing population, the need for facilities and cost management will require a systemic change in the value chain of health care services.

Primary care providers

As a consequence to wider health reform, there will be an increased partnership and likely self-management of primary healthcare services by health insurers, and an emphasis on same-day surgery and other low complexity procedures assisting funds to manage costs.

The evolution of big data

There is a raft of data already available to PHI's that is mostly siloed across the organisation, with the inclusion of the Internet of Things (IoT) devices and access to broader health records from service providers. PHIs will be in a position to offer a more focussed and tailored customer experience putting members first.

Collaboration and consolidation

Combining the pressures of cost management, competition and regulation, it is very likely that the PHI market will see a degree of consolidation as organisations look to attain scale to remain competitive. Conversely, there would also be opportunity amongst the members-owned cohort to continue collective marketing and potentially joint arrangements for facilities whether in dental, eye care or primary care services.