First and foremost, we would like to remind the government and policy makers that consumers, the people who use the health system and for whom it was created, should be at the centre of all of decisions. As advocates for consumers, who do not have a financial stake in this, we offer suggestions which are based on the reality of consumers’ use of their PHI and how the health system can best serve them. Our key principles in this area are:

• That consumers’ ability to choose to be private patients in public hospitals be maintained
• That PHI policies that are public hospital only should still attract government incentives particularly given their importance for rural consumers
• That patients should be treated according to clinical need, not ability to pay. This needs to be strengthened by improved monitoring and data collection on this issue.

As our submission highlights, most of the options presented in this paper and the broader discussion around PHI do not currently have consumers at the centre and may be seen to penalise consumers, instead of supporting them. While we acknowledge the importance of equitable sharing of funding between the commonwealth and states and territories, changes should not be made which would limit patient choice and potentially increase confusion or costs for individual consumers. We suggest that while this issue is not unimportant, that changes in this area are unlikely to have substantial or wide-ranging affects in the areas of value or affordability for consumers.

The discussion paper has many assumptions and conclusions that we suggest are not clearly substantiated with the evidence offered. For example, the paper argues that “(i)f the number of private patients in the public sector had grown at the same rate as private patients in private hospitals since 2010-11, premiums in 2015-16 would have been about 2.5% lower than they actually were” (page 4). It is unclear how these figures were derived.