The Future of Private Health Insurance with Ben Harris

Private health insurance plays a critical role in Australia’s healthcare system — but its value is often misunderstood. In this episode of Innovation Insider, I speak with Ben Harris, Director Policy and Research at Private Healthcare Australia, about the forces shaping the sector and the innovations that could define its future.

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Balancing Medicare and Expanding Access

Ben describes private health insurance as a vital partner to Medicare, covering hospital care, elective surgeries, and a range of ancillary services.

“Private health insurance brings additional funds into the system, which improves equity and access.”

While its purpose hasn’t changed, public perceptions have shifted over the past 40 years. Many people, having only known the current dual system, are unaware of the alternatives that existed before the 1980s.

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From Paying Claims to Improving Health

Ben believes health funds have a responsibility to go beyond simply paying claims.

“Health funds have a responsibility to work with customers to improve their health, not just pay their bills.”

This shift is evident in initiatives such as no-gap knee reconstructions, dental clinics in underserved areas, and digital health tools that help members stay healthy and access care outside hospital.

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Innovations Making an Impact

Two areas of innovation stand out from our discussion:

• No-gap private hospital services, such as those at Adeney Private Hospital, which reduce out-of-pocket costs for patients.
• Remote monitoring and online health coaching, including mental health support, giving consumers targeted information and care beyond hospital walls.

Ben also sees a future where individuals own their health records, with AI analysing personal data to deliver personalised health advice.

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Rethinking Incentives

We explored how Australia’s fee-for-service model can encourage longer hospital stays than necessary. For example, knee replacement patients in Australia typically remain in hospital longer than in Europe. Ben believes insurers can offer better incentives for earlier discharge and appropriate out-of-hospital care.

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Using Data for Prevention

Multimorbidity — living with more than one chronic disease — is becoming more common. Ben shared how data can be used for secondary prevention:

“If you have arthritis under the age of 50, you’re twice as likely to have a mental health condition. We can use that knowledge to prompt earlier interventions.”

Private health insurers already invest heavily in prevention, which helps members, reduces costs, and keeps premiums lower under Australia’s community rating system.

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Value-Based Healthcare

Ben notes that value-based healthcare is emerging in Australia but must prioritise eliminating waste. Removing low-value or no-value care is essential to maintain affordability for the 15 million Australians who pay premiums.

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Navigating System Challenges

We discussed the ongoing tensions between hospitals and insurers, heightened by inflation and financial pressures on hospital operators. Ben emphasised the need for better data on hospital operations to guide where beds and services are needed, and acknowledged the shift towards community-based care for many services.

Private Healthcare Australia, representing 98% of people with private health insurance, works on policy, research, and advocacy to ensure the system supports access to care and remains consumer-focused.

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🎙 Listen to the full conversation for more on AI in personalised health, incentives for better care, and the role of prevention in strengthening the healthcare system.