First steps towards price transparency: comparability of online out-of-pocket tools from Australian private health funds

Abstract

OBJECTIVE Our objective was to compare and contrast the information three Australian private health insurance funds have provided on their online out-of-pocket cost tools, and to consider the implications this has for price transparency in Australia. METHODS We downloaded the website data from HCF, Bupa and Medibank on the 18 February 2019. We reviewed the information and statistics provided on these pages, and compared procedures across funds if their pages had referred to the same Medical Benefits Schedule (MBS) item/s. We extracted the descriptions of the claims data used, the types of statistics provided, the out-of-pocket estimates, the total procedure cost, the MBS Items referenced and the assumptions the funds’ described on their pages. RESULTS HCF stated the MBS items used to select the claims data for their estimates, while Bupa and Medibank only referred to common MBS items associated with the procedures. HCF had on average 1.44 more MBS items listed than Bupa and 2.08 more than Medibank. The funds organised procedures differently, such as HCF providing separate cost estimates for vaginal, abdominal and keyhole hysterectomy compared to Medibank’s single estimate for hysterectomy costs. CONCLUSIONS These funds have started to address the need for transparent out-of-pocket cost information, but the differences across these pages demonstrate complexities and the potential obfuscation of cost data.

Publication
First steps towards price transparency: comparability of online out-of-pocket tools from Australian private health funds