Hrm20020 Performance Management And Innovation: Assessment Answer

Answer:

Introduction

Private health insurance 2017 reforms remain to be the reform that the Australian Government announced on 13th October in 2017. The reform focused on a wide-ranging package of different reforms to private health insurance to make it simpler together with more affordable for all people within Australia (Health Fund News, 2016). The proposal of the reform was planned to take place between October 2017 and February 2020.  Private health insurance 2017 reforms aimed to provide affordability, transparency, as well as better access to mental services that aimed at benefiting the Private Health Insurance clients. In addressing affordability of health services, these reforms aimed at reducing costs in the healthcare sector that has been on rising year-on-year (Buchmueller, Fiebig, Jones, & Savage, 2013). Higher cases of chronic disease in Australia, more expensive medical technologies, the ageing population, together with the decrease percentage of authority rebates have all added pressures to premiums of health insurance and contributed to concerns over the affordability of private cover. According to Trafalski et al., (2013), all these cases had made the Turnbull government announce the wide-ranging packaging of reforms to make private health insurance simpler and more affordable for Australia. It is clear that every dollar matters to families of Australian and these reforms will attain best value for families and create policies simpler to understand.  Therefore, private health insurance 2017 reforms are essential and valuable section of the health system of Australia.

Private health insurance 2017 reforms entail the idea of categorizing hospital insurance product as gold or silver or bronze or basic and implementing standardized clinical categories for treatment for treatments to make it clear what is as well as what is not covered in policies. The reform aimed at boosting the powers of private health insurance Ombudsman and improving its resources to ensure client complaints to be resolved quickly and clear (Health Fund News, 2017).  The government’s latest reforms are designed with the objective to address the affordability of cover of health in Australia. The reforms comprise of reductions to the prostheses list benefits that different private health insurers pay that are estimated to be capable o delivering about two hundred million dollars in savings to the PHI industry. For instance, this reform has made Medibank to be committed to passing on these savings in full to their clients (Finkenstädt & Niehaus, 2015). The reform ensured that insurers to be capable of offering health cover options with the seven hundred and fifty dollars excess that qualify for the Medicare Levy Surcharge exemption. The reform ensured that choosing the policy with the higher excess can have the impact of reducing an individual health cover premiums (Tovino, 2017). Therefore, this report addresses different issues concerning a recent health reform “Private health insurance 2017 reforms”.


Description of Private health insurance 2017 reforms

The reform aimed at introducing a new Gold, Bronze, Silver, Basic system of classification that intended to make it easier to compare as well as choose products of private health insurance. The major comparison website such as privateealth.gov.au will be upgraded to ensure at-a-glance comparisons easier (Grunow & Nuscheler, 2013). The reform aimed at ensuring that the government is capable of assembling the team of experts to set different guidelines around how out-of-pocket charges are communicated to different patients. The reform discounted for individuals’ between the age of eighteen and twenty-nine of age. Through the reform, from April 2019, private health insurers will be capable to provide discounts to eighteen and twenty-nine years of age taking out their hospital cover (Alex & He, 2017). Private health insurance 2017 reforms ensure that the health insurance system operates best when there is participation from the broad range of age groups, so any measures encouraging teenagers to join the insurance of health are a good issue.

Some of the health reforms within private health include prostheses list benefit reductions, accessing mental health services, and Gold/Silver/Bronze/Fundamental product categories. Other reforms comprise of discount for 18 to 29-year-olds, increasing minimum excess level, standard clinical definition, and removal of rebate for some natural therapies (Spinks & Hollingsworth, 2012). The reform focuses on improving the access to travel together with benefits of accommodation for regional along with rural areas. Prostheses list benefit reductions aimed at ensuring that the minimum benefits payable for almost all medical devices listed on the Prostheses list will be reduced. It estimated to deliver amount that amounts to about two hundred million dollars in savings for clients in the entire operations of industry in coming years (Giovanis, 2016). Furthermore, accessing mental health services through these reforms allows patients with limited mental cover of health for at least twenty-four months will be capable to upgrade their cover to access-in hospital mental health care services without serving the waiting duration for the upgrade of cover. Holders of policy can then be capable to use this exemption from the existing two month period of waiting at once. The reform aims at ensuring that the government will aim at increasing the permitted excess el for families. The idea allows consumer to be capable of choosing product with greater excesses in return for lower premium while also attaining the requirements for Medicare Lev Surcharge exemptions.  The policy aims at ensuring that insurance company offer to travel together with accommodation benefits under cover of hospital instead of only under general policies of treatment (Brown, 2017). However, private health insurers through the reform will need to utilize standard clinical definitions across all of their documentation together with across all reforms.

Targeted customers and providers, stakeholders

The primary target for the private health insurance 2017 reforms in Australia were both public together with private health services. These comprise of mental health managers, providers, professionals, along with other staffs. The other targets by this reform were mental health consumers and their families and carers (Sook-Jung, 2015). Mental health policymakers were other targeted stakeholders and mental health advocates were other targeted clients by the reforms. The primary audience of this reform reflects stakeholders that are primarily with mental health clients. It is recognized that there may be particular considerations for various mental health service setting through the reforms (Harley et al., 2011). For instance, a child together with adolescent mental health services, aged individuals mental health services, forensic mental health services, and for varied groups of consumers that comprise of Aboriginal and Torres Strait Islanders and individuals from culturally and linguistically diverse backgrounds. Moreover, secondary audience or targeted group by these reforms reflect sectors other than mental health services where there exist a chance to affect different policies and protocols, processes or to improve relationships of work (Petilliot, 2017). These secondary audiences consist of acute health care services more broadly compared to acute mental health care specifically rural acute health care services. It also targeted emergency services like provision of ambulances, air services, and other beneficial services to improve conditions of the sick.

Mechanisms used

The major mechanism used by these reforms was to reduce or control costs of seeking or attaining health care services to be affordable to all people within Australia. The mechanism used was to divide cost-control strategies into those that focus on the financing side versus those that affect the payment side of the stream of funding (Leung, Trevena, & Walters, 2012). The policy aimed at facilitating access to health care by eliminating or diminishing financial barriers to achieving care. The reforms used the mechanism of financing the flow of money from an individual and employers to the plan of health insurance (Finkenstädt & Niehaus, 2015). It also used the mechanism of reimbursement that focuses on the flow of dollars from different plans of insurance to hospitals, physicians, and other healthcare providers.

Compliance requirements

The major requirement for private health insurance 2017 reforms was the regulatory reform framework for Australian healthcare insurance that is necessarily complex with regions that independently govern how insurance organizations must work within their legislative limits. The reforms aimed at provision of standard accessibility to quality and affordable health services to every individual around Australia (Einarsdóttir et al., 2012). It complied with legislative requirements by using web standards and designing the reforms to maximize accessibility of health care in line with the requirements of health care acts. It aimed at supporting intermediaries in the global arena by forming the part of core values of health management. Compliance requirement targeted at promoting the safety and soundness to the organization that it regulates (Harley et al., 2011). It also focussed on contributing to the securing of the appropriate degree of protection for individuals that are or might become holders of policy for private health insurance 2017 reforms.

Accountability measures

Before these reforms, there was no single, unified audience for data on health care quality, but rather the variety of audiences with varied and sometimes having interests and priorities that are conflicting. The reform brought about the accountability measures y improving professional approach that relied on the actions of private sector accreditation groups, associations of trade, health plans, hospitals, together with different health providers to assure quality (Health Fund News, 2016). The other measure of accountability was focus on market-driven approach that relied on the application of quality data by healthcare purchaser and consumers in selecting plans and providers (Trafalski et al., 2013). Additionally, private health insurance 2017 reforms ensured the accountability measure by focusing on public-sector approach that relies on the oversight, regulatory, along with purchasing actions of government at the federal state and different local levels to assure quality.

How effectiveness private health insurance 2017 reforms will be evaluated or demonstrated

Process of quantifying the inputs together with outcomes of mental services health interventions will be essential in determining overall value to the proposed healthcare system within Australia. The rate of diseases occurrence will be used in evaluating the significance of the reform (Petilliot, 2017). The evaluation can be through process of understanding the present allied healthcare services in the region, expenditures by different health stakeholders and outcomes after the provision of services. Moreover, evaluation will be vital by ensuring that there is an awareness of existing healthcare services priorities in Australia that comprise of cost-saving potential, management of risk, along with improvement of quality (Grunow & Nuscheler, 2013). The use of economic together with quality analysis can be vital in the evaluation process by determining current and benchmarking models that are appropriate in provision of affordability, transparency, as well as better access to mental services to Australian community.

Recommendation for further reforms

There is the need to develop new and better measures to eliminate cases of inability to come to terms with overarching issues that are holding back progress in both public and private sectors towards the provisions of affordability, transparency, as well as better access to mental services to Australian community (Brown, 2017). The use of scope, funding, risk adjustments, and timing can be essential in forming the efforts that can be used to measure and report healthcare quality that invariably confronts a wide range of complex concerns. There is a need for the proposed reforms to focus on usage of comparative costing reports across sites to borrow ideas on how to implement the policy into appropriate usage (Spinks & Hollingsworth, 2012). The reforms should continue to involve with other health stakeholders to develop and implement the affordability, and transparent healthcare delivery services to ensure that every individual in Australia remains healthy.

Conclusion

From the time of its proposal, private health insurance 2017 reforms have remained to be essential and valuable part of the healthcare system within Australia. It has helped in supporting people in regional as well as rural areas as insurers are able to provide travel and accommodation advantages for individuals in the region with the need to travel for treatment.  Private health insurance 2017 reforms are currently providing affordable, transparent, as well as better access to mental services that aimed at benefiting the Private Health Insurance clients. In addressing affordability of health services, these reforms have focused on reducing costs in the healthcare sector that has been on rising year-on-year.

References

Alex Jingwei He, & He, A. J. (2017). Introducing voluntary private health insurance in a mixed medical economy: are Hong Kong citizens willing to subscribe? BMC Health Services Research, 17, 1–10. https://doi.org/10.1186/s12913-017-2559-7

Brown, P. (2017). Private health insurance - a good deal in rural and remote Australia? Australian Journal of Rural Health, 25(5), 319. https://doi.org/10.1111/ajr.12401

Buchmueller, T. C., Fiebig, D. G., Jones, G., & Savage, E. (2013). Preference heterogeneity and selection in private health insurance: The case of Australia. Journal of Health Economics, 32(5), 757–767. https://doi.org/10.1016/j.jhealeco.2013.05.001

Einarsdóttir, K., Kemp, A., Haggar, F. A., Moorin, R. E., Gunnell, A. S., Preen, D. B., … Holman, C. D. J. (2012). Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms. PLoS ONE, 7(7), 1–5. https://doi.org/10.1371/journal.pone.0041436

Finkenstädt, V., & Niehaus, F. (2015). Rationing and Differences in Care in Health Systems. World Medical Journal, 61(1), 17–21. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=102370655&site=ehost-live

Giovanis, E. (2016). Who Pays More: Public, Private, Both or None? The Effects of Health Insurance Schemes and Health Reforms on Out-of-Pocket and Catastrophic Health Expenditures in Turkey. SSRN Electronic Journal. 1(1), 1–12. doi: 10.2139/ssrn.2784936

Grunow, M., & Nuscheler, R. (2013). Public And Private Health Insurance In Germany: The Ignored Risk Selection Problem. Health Economics, 23(6), 670-687. doi: 10.1002/hec.2942

Harley, K., Willis, K., Gabe, J., Short, S. D., Collyer, F., Natalier, K., & Calnan, M. (2011). Constructing health consumers: Private health insurance discourses in Australia and the United Kingdom. Health Sociology Review, 20(3), 306–320. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=74387093&site=ehost-live

Health Fund News. (2016). Journal of the Australian Traditional-Medicine Society, 22(3), 172–175. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=118335126&site=ehost-live

Health Fund News. (2017). Journal of the Australian Traditional-Medicine Society, 23(2), 110–113. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=123962747&site=ehost-live

Leung, K., Trevena, L., & Walters, D. (2012). Development of an appraisal tool to evaluate strength of an instrument or outcome measure. Nurse Researcher, 20(2), 13–19. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=83621389&site=ehost-live

Petilliot, R. (2017). The Effect of Private Health Insurance on Self-Assessed Health Status and Health Satisfaction in Germany. SSRN Electronic Journal. doi: 10.2139/ssrn.3051718

Sook-Jung Hyun. (2015). Factors Associated with enrollment in new private health insurance and additional private health insurance. Health Service Management Review, 9(4), 21-28. doi: 10.18014/hsmr.2015.9.4.21

Spinks, J., & Hollingsworth, B. (2012). Policy Implications of Complementary and Alternative Medicine Use in Australia: Data from the National Health Survey. Journal of Alternative & Complementary Medicine, 18(4), 371–378. https://doi.org/10.1089/acm.2010.0817

Tovino, S. (2017). Disparities in Private Health Insurance Coverage of Skilled Care. Laws, 6(4), 21-22. doi: 10.3390/laws6040021

Trafalski, S., Briffa, T., Hung, J., Moorin, R., Sanfilippo, F., Preen, D., & Einarsdóttir, K. (2013). Effect of private insurance incentive policy reforms on trends in coronary revascularisation procedures in the private and public health sectors in Western Australia: a cohort study. BMC Health Services Research, 13(1), 13-65. doi: 10.1186/1472-6963-13-280

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