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Several questions remain unasked in the ongoing debate about healthcare affordability in Australia.

Why have only private health insurance premiums reliably kept up with inflation among all the major healthcare cost components: doctor’s fees, Medicare benefits, private insurance benefits, government health funding, and public hospital salaries?

Is this true?

Health Insurance Premiums: Always Rising

There’s no debate here: private health insurance premiums have risen almost every single year and nearly always at a rate above the Consumer Price Index (CPI). Over the last 28 years, there have only been six where inflation was higher than the average industry premium increase.

Between 2002 and 2024, private health insurance premiums increased by 5.1% annually, even as inflation averaged almost half that (2.74%) over the same 22-year period. Private insurers justify these increases by pointing to rising treatment costs, increased service use, and an ageing population. While these are all factors, the consistent premium increases have still allowed record profits among the biggest insurers: BUPA, one of Australia's Big Two with Medibank Private, recently reported over AU$ 900 million in profit in the Asia Pacific region.

✅ Conclusion:

Yes, health insurance premium increases have exceeded inflation.

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The proposal

Private Healthcare Australia (PHA) CEO Rachel David advocates for a "bundled care" maternity costing model where midwives, GPs, and obstetricians offer fixed-cost maternity packages. This model promises low-cost, full-transparency care across antenatal visits, delivery, and postnatal care – supposedly providing affordable options by allowing private midwives and GPs to manage low-risk pregnancies independently, in parallel with specialist obstetricians funded by the same bundled care model.

The hidden agenda

The critical question remains unasked: Why is the PHA, representing Australia's largest health funds (98% of the market, predominantly for-profit insurers), pushing so aggressively for this model? What benefits do PHA members, such as BUPA, which recently reported over AUD$900 million in profit in the Asia Pacific, have in strongly advocating for this funding model?

David's argument hinges on the uncited claim that only 14% of deliveries require an obstetrician, contradicting the Australian government's own data. Official AIHW statistics show delivery mode alone dictates that over 50% of births require specialist obstetricians before even considering complications like haemorrhage, perineal trauma or retained placentas.

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As we witness the global consequences of expertise rejection, particularly in the United States, I've been considering what truly characterises expertise beyond just specialist domain knowledge and experience – a question at the heart of anaesthesia and critical care practice.

Many doctors are first drawn to anaesthesia as a specialty because we desire control. We imagine ourselves controlling airways, physiology, and pharmacological interactions – sometimes, we even fancy we have some control over our surgical colleagues.

Yet we don't actually control any of these things. Instead, we modify, ablate, and amplify, working within a complex interaction between the patient, physiology, surgery, and our interventions. Our expertise lies not in absolute control but in understanding and adapting to uncertainty.

As news from the US shows a country embracing the "find out" phase of cascading bad decisions (some people just need to touch the stove to learn it's hot), a culture of expertise rejection dominates. This rejection exposes itself in curious ways, including assumptions that success in one field, say, building electric cars or reusable rockets, represents translatable expertise to other specialist fields.

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A grim discontent with healthcare in many Western countries is intensifying, exposing cracks in a strained system.

The recent murder of a US health insurance CEO, along with the dark wave of public sympathy for the assailant, warns us that health system inequity and failure may culminate in extreme ways.

Australia faces its own challenges: escalating medical costs and burdened public and private hospitals, even as international healthcare corporations post record profits. The growing corporatisation of healthcare, driven by insurance companies and hospital conglomerates, is a concerning glimpse of one possible future for medical care. A significant portion of Australian healthcare funding now leaves our shores for these international corporations and their shareholders.

Yet media coverage presents an unbalanced narrative. While corporate healthcare profits receive measured reporting, medical practitioners face scrutiny and criticism, frequently without evidence. I wrote the piece below in response to a two-year media campaign suggesting widespread billing fraud among Australian doctors, particularly anaesthetists and surgeons. Much of this reporting revealed misunderstandings of the health system and medical billing while ignoring how such stories serve corporate healthcare interests, even as the same corporations encourage attacks on doctors from the sidelines.

I submitted this op-ed to several Australian media outlets, but it remains unpublished. I'm sharing it here to contribute to a balanced understanding of the role of medical professionals in Australian healthcare.

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Three interesting recent studies looking at specific choices around anaesthetic technique. In the Canadian Journal of Anesthesia, da Silveira reviews the benefits of opioid-free laparoscopic surgery; in the Journal of Cardiothoracic and Vascular Anesthesia, Ford goes deep on the pros and cons of different anaesthetic techniques for AF ablation procedures; and finally in the JCA, Liu reports on a single-centre RCT investigating the beneficial effects of LMAs on atelectasis.

Opioid-Free Laparoscopic Surgery: Less Nausea, Similar Pain Control

An interesting meta-analysis from da Silveira et al. explores whether we can effectively manage minimally invasive abdominal surgery without using opioids - an important question given how common opioid-related side effects are.

This was a comprehensive systematic review and meta-analysis of 26 randomised controlled trials, including 2,025 patients. The researchers specifically compared opioid-free versus opioid-containing anesthesia in minimally invasive abdominal surgeries. They were particularly interested in looking at side effects like PONV and bradycardia, as well as pain control and recovery times.

The results were quite interesting. The authors found that opioid-free anaesthesia:

• Reduced PONV by 45% (from 24% to 13% / RR CI 0.40 to 0.74).
• Led to slightly lower immediate postoperative pain scores (though not clinically significant).
• Required less postoperative opioid use in the first 2 hours.
• Showed no difference in recovery room length of stay.
• Showed no increase in bradycardia, a previously noted concern when using intraoperative dexmedetomidine.

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