Summary of the first meeting of the Private Health Ministerial Advisory Committee – Clinical Definitions Working Group, 22 March 2017

This page contains the meeting summary for the first meeting of the Private Health Ministerial Advisory Committee – Clinical Definitions Working Group, 22 March 2017

Page last updated: 29 March 2017

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Dr Andrew Singer, Chair Dr Melinda Williams, Peoplecare
A/Prof Amanda Walker, Australian Commission on Safety and Quality in Health Care James Harrison, St.LukesHealth
Brian Hanning, Australian Health Service Alliance Dean Breckenridge, Doctors’ Health Fund
Dr Roderick McRae, Australian Medical Association James Downie, Independent Hospital Pricing Authority
A/Prof Ian Norton, Gastroenterological Society of Australia Katharine Barrett, nib
Dr Maurizio Damiani, Australian Orthopaedic Association Dr David Rankin, Medibank
A/Prof Alex Hunyor, Australian Society of Ophthalmologists Dr Andrew Cottrill, HCF
Will Hanham, Department of Veterans’ Affairs Dr David Love, Royal Australasian College of Surgeons
Jo Root, Consumers Health Forum Prof Stephen Duffy, The Cardiac Society of Australia and New Zealand
Dr Gary Speck AM, Council of Procedural Specialists  
Susan Azmi Carla Roots
Josh Shanahan  


Kate Munnings, Ramsay Health Care; David McGregor, Private Health Insurance Ombudsman; and Elizabeth Foley, Australian Nursing and Midwifery Federation.

1. Welcome and opening statement

  • The Chair delivered his opening statement, advising members that the purpose of the Working Group is to provide advice to the Private Health Ministerial Advisory Committee (PHMAC) on possible options to standardise clinical definitions.

2. Introductions

  • The Chair provided members an opportunity to introduce themselves.

3. Conflict of interest

  • The Chair noted that he had considered members’ declarations of their interests and did not consider there were any declared conflicts that would prevent participation in the Working Group.
  • Members did not declare any new conflicts of interest.

4. Issues paper overview and presentation

  • The Secretariat provided a presentation about why clinical definitions need to be considered and the role of the Working Group. A key concern for consumers is product complexity, and inconsistent clinical definitions make comparing private health insurance products more difficult. The role of the Working Group is to develop a list of standard clinical definitions which present clear information so consumers can more easily compare private health insurance policies and understand their own product.
  • The presentation included a comparison of the different clinical definitions used by insurers in their own product material and the regulated definitions required as part of a Standard Information Statement (SIS).
  • There are currently 13 clinical definitions listed in the SIS: cardiac and cardiac related services; cataract and eye lens procedures; pregnancy and birth related services; assisted reproductive services; joint replacements; hip and knee replacements; hip replacements; dialysis for chronic renal failure; gastric banding and related services; sterilisation; non-cosmetic plastic surgery; hospital treatment for which Medicare pays no benefit; and other services.
  • The clinical definitions in the SIS are regulated but insurers also use their own clinical definitions across their insurance products. This inconsistency can make it difficult for consumers to compare products.
  • An example of a SIS clinical definition that varies significantly is ‘gastric banding and related services’. Other clinical definitions used by insurers for this SIS category include: weight loss surgery; obesity related treatment; and bariatric surgery.

5. Discussion of issues

  • The Working Group acknowledged that clinical definitions currently used can be confusing for consumers and this needs to be considered when developing the new list of clinical definitions.
  • The Working Group agreed:
    • to use the list of clinical definitions in the current SIS as a basis for developing a new list of standard clinical definitions;
    • that each clinical definition should have a brief description to assist the consumer;
    • there should be a list of procedures under each clinical definition; and
    • that the list of clinical definitions should be suitable for use by a variety of groups e.g. consumers, providers, insurers, intermediaries and government.
  • The Working Group also discussed whether the standard list of clinical definitions should be used beyond the SIS, and if so whether this should be regulated by government or private health sector-led. The Working Group agreed that it would further consider this issue at its next meeting.

6. Determining the list of clinical definitions

  • The Working Group discussed the clinical definitions currently listed in the SIS and: whether each clinical definition is still required; whether individual clinical definitions need updating; and if additional clinical definitions are needed.
  • The Working Group agreed it will continue to develop the list of standard clinical definitions at the next meeting.

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