Each year, the Australian Healthcare Index provides a snapshot of how Australians are feeling about their healthcare system. This year’s results should make every insurer pause.
Despite solid coverage rates, private health insurance remains stuck in a value and trust crisis. For the fourth consecutive year, the sector recorded a Net Promoter Score of –14, with only one in four Australians saying they would recommend their fund. More tellingly, “poor value for money” has overtaken affordability as the leading cause of dissatisfaction.
That shift speaks volumes about where the sector stands.
A Turning Point for Perception
Australians are questioning what they receive for the premiums they pay. When everyday costs keep rising and people are delaying care, skipping medications, and reducing coverage, the idea of value becomes deeply personal.
This moment calls for more than price restraint. It calls for insurers to prove their relevance.
Opportunity 1: Create Value Members Can Feel
Experience is overtaking price as the driver of satisfaction. In the Index, extras cover, hospital benefits, and customer service ranked highest among those who would recommend their insurer.
Members are looking for reassurance and fairness in every interaction. Insurers that simplify processes, communicate clearly, and show genuine care at key moments will earn loyalty that advertising cannot buy.
Opportunity 2: Make Prevention Part of the Business Model
The Index revealed that three in four Australians are changing their healthcare behaviour because of cost pressures. Many are skipping GP visits and dental check-ups, which will inevitably lead to higher downstream costs.
Prevention is no longer a nice-to-have. It is a sound business strategy. By investing in early intervention, health coaching, and digital support, funds can protect both member health and long-term affordability.
Opportunity 3: Use Digital Health to Build Access and Trust
Telehealth usage climbed back to 45% in 2025, and satisfaction levels are strong. For many people, digital care is now the most convenient and affordable way to access help.
Insurers are in a unique position to expand this access. Partnerships that enable remote monitoring, virtual consultations, and connected care can reduce pressure on hospitals while improving the everyday experience for members.
Opportunity 4: Reconnect with Younger Australians
Members aged 18 to 34 are most likely to downgrade or cancel their cover. This generation expects flexibility and personalisation. They want solutions that support daily health, not just hospital admission.
Health funds that adapt products and incentives to fit modern lifestyles will hold a stronger future position. Those that do not will see the base of the system gradually weaken.
Opportunity 5: Link Innovation to Measurable Performance
Across our PHI Innovation Report, one message continues to surface: innovation only matters when it improves performance. That means better access, fairer costs, and measurable health outcomes.
The next phase of leadership in PHI will come from funds that demonstrate results in these areas. Lower hospital dependence. Stronger retention. Healthier communities.
That is where relevance will be rebuilt.
The Bottom Line
Australians still believe in the promise of private health insurance, but they are struggling to see the return. The opportunity for insurers is to make that value clear again.
Not through slogans. Through action.
Check out how Australia’s top insurers like Medibank, Bupa, HCF, nib & HBF are increasing value for their members in our 2025 PHI Innovation Report 👇🏻