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AMA Report Reveals Erosion of Value in Private Health Insurance

Examining the Declining Benefits Amid Rising Premiums

AMA Report Reveals Erosion of Value in Private Health Insurance?w=400

The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.

The Australian Medical Association (AMA) has released its latest Private Health Insurance Report Card, highlighting a concerning trend where Australians are paying higher premiums for private health insurance while receiving diminished value in return.
The report indicates that nearly 70% of policies now contain exclusions, limiting the coverage available to policyholders.

AMA President Dr. Danielle McMullen emphasized that the value of private health insurance is 'eroding,' with premiums rising sharply and outpacing both inflation and wage growth. This situation has led to a significant number of Australians questioning the affordability and worth of maintaining private health coverage.

One of the key findings of the report is the substantial increase in premiums over the years. Between 2008 and 2024, premiums climbed more than 100%, while the indexation of the Medicare Benefits Schedule increased by less than 20% during the same period. This disparity underscores the financial burden placed on policyholders.

In response to these findings, the AMA has called for urgent reforms, including the establishment of an independent Private Health System Authority to oversee the sector and ensure that insurers provide better value to consumers. Additionally, the AMA advocates for a mandate requiring insurers to return at least 90% of premiums to consumers in the form of benefits, aiming to enhance transparency and fairness within the industry.

For health care professionals, these developments are particularly pertinent. The rising costs and decreasing value of private health insurance can impact both personal coverage and the broader healthcare system's dynamics. It's essential for professionals to stay informed about these changes and consider how they may affect their practice and patient care.

As the debate over private health insurance continues, stakeholders across the healthcare sector are encouraged to engage in discussions about potential reforms and advocate for a system that balances affordability with comprehensive coverage for all Australians.

Published:Tuesday, 10th Mar 2026
Source: Paige Estritori

Please Note: If this information affects you, seek advice from a licensed professional.

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The ratio of claims paid by an insurer to the premiums earned, used as a measure of profitability.