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Health plan payment in Australia

Paolucci, F., Sequeira, A.R., Fouda, A. and Matthews, A. (2018) Health plan payment in Australia. In: McGuire, T.G. and van Kleef, R.C., (eds.) Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets. Academic Press, pp. 181-208.

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The Australian healthcare system is characterized by a mix of public and private financing and provision of healthcare services. The health insurance system consists of a National Health Insurance/Service and voluntary private health insurance (PHI). The latter is regulated through the Private Insurance Act (2007) which established a complex mix of subsidies and regulatory instruments (e.g., community rating, open enrollment, ad valorem premium-subsidies and tax-incentives), and provides for the operation and administration of the Risk Equalization Trust Fund. The Australian health plan payment scheme constitutes a combination of risk sharing and risk equalization. The duplicative nature of the current private/public mix (those with PHI remain covered by the national public system) and the potentially inefficient mix of subsidies have contributed to some important issues such as overinsurance, a high market concentration, risk selection, market segmentation, and a misallocation of subsidies. Increasingly, concerns are rising about the affordability, efficiency, and sustainability of the Australian healthcare system.

Item Type: Book Chapter
Murdoch Affiliation(s): Sir Walter Murdoch School of Public Policy and International Affairs
Publisher: Academic Press
Copyright: © 2018 Elsevier Inc.
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