Over the past six months, leaders from more than a dozen Australian health funds have completed our PHI Benchmarking Scorecard—a diagnostic tool that measures readiness across 15 drivers shaping the future of private health insurance.
Unlike a survey or perception check, the scorecard is based on a structured set of yes/no questions. It examines whether the right systems, processes, and capabilities are in place—not just whether leaders feel prepared. The results are drawn directly from the operational reality of each fund.
And that reality? It’s sobering.
A Sector Built for Yesterday’s Challenges
The average benchmark score across all funds is just 47%.
That means most insurers only meet half the baseline criteria needed to confidently tackle the biggest shifts in the industry.
Here’s where the gaps are loudest:
- Technological Integration (22%): Despite all the talk of digital transformation, most funds still lack the infrastructure and internal coordination to deliver it at scale.
- Telehealth & Digital Health Services (25%): What surged during COVID is now stuck in pilot mode, with little evidence of true operationalisation or value capture.
- Dementia & Ageing Population (31%): One of the most pressing system-wide challenges is being met with limited readiness, despite its cost and demographic inevitability.
These aren’t niche areas—they’re core to the future sustainability and relevance of the sector.
Weaknesses in Purpose-Driven Strategy
Several other drivers that speak to long-term impact and member wellbeing also scored alarmingly low:
- Health Risk Factors (34%)
- Health Inequalities (36%)
- Mental Health Support (45%)
In short, most funds lack the structural readiness to tackle the very problems they were designed to help solve.
Bright Spots: Structural Leverage & Price Strategy
There are a few areas where funds are clearly more prepared:
- Premium Price Pressure (76%) – Pricing models and member communications are well-developed in most cases.
- Economies of Scale (68%) – Funds large and small are leveraging shared services and group structures effectively.
- Customer Expectations (49%) and Chronic Disease (49%) – These landed near the midpoint but still point to room for uplift.
These results suggest that while funds have a handle on immediate commercial pressures, they are less equipped to respond to deeper system shifts or long-term transformation.
What This Means for Your Fund
This isn’t a reflection of apathy or incompetence. It’s a reflection of just how complex, fragmented, and constrained the private health system has become.
But now that we have data, we also have a roadmap. The scorecard doesn’t just highlight problems—it reveals where innovation efforts are most urgently needed and where foundations are already in place to build from.
If you’re curious how your fund compares—or want to pinpoint your biggest levers for improvement—you can complete the PHI Benchmarking Scorecard here.
And if you already know where your weaknesses are, get in touch with us to discover how our Scenario Planning Workshop products can help you balance your preparedness (or lack there-of) with the drivers that are most significant for your fund.