Our Position – Private patients in public hospitals
October 13, 2025
Pope Leo’s Dilexi te sets poverty as Church priority
October 13, 2025
Background
The current Type C certification process creates a significant administrative burden because it no longer reflects contemporary models of clinical care, the needs of an ageing population, or the evolving value proposition of private health insurance. Under the Private Health Insurance (Benefit Requirements) Rules 2011, a treating practitioner must complete and sign a certificate confirming that an admission was clinically necessary before benefits can be paid. This requirement adds considerable paperwork, manual handling, and repeated correspondence between hospitals, doctors, and insurers. Insurers frequently query or reject certificates on technical grounds, even where clinical necessity is evident, leading to delays, inconsistent claim outcomes, and additional workload for hospital administrative teams. The certification framework also fails to account for how MBS items are actually used in practice, particularly where MBS allocation does not align with majority utilisation patterns.
The Department of Health, Disability and Ageing’s consultation paper, Private Health Reform Options (January 2025), and the establishment of the Private Health Chief Executive Forum in late 2024 both highlighted the need to reduce administrative complexity and modernise the private health insurance system to improve sustainability. A key outcome of these discussions was the recognition that Type C certification requirements often create unnecessary administrative and financial burdens for hospitals, clinicians, and insurers, without providing meaningful consumer protection. The Department has identified 146 MBS items for potential reclassification and is proposing to move these items into the PHI Procedure Type of “unlisted”.
