Doctors' Health Fund (AMA)

Performance

The Private Health Insurance Ombudsman prepares an annual report on the service delivery and performance of Australian health insurers. The following is a selection of statistics about this health insurer - the full report and an explanation of these figures is available from the Ombudsman's website. Please note information is not provided for some insurers in some states, as there are insufficient numbers reported to APRA for states in which the insurer does not have a large membership.

Performance Insurer Industry
Benefits as a % of contributions 82.9% 85.8%
Management expenses (% cont) 10.4% 8.9%
Management expenses (average policy) $547 $322
Surplus 6.7% 5.6%
Member retention (%) 88% 82%
Coverage ACT NSW VIC QLD SA WA TAS NT
Hospital Related Charges Covered 90.8% 91.7% 92.3% 92% 89.5% 90.9% 91.7% 89.6%
Industry Result 83% 90.1% 92% 90.4% 94.8% 93.8% 93.9% 90.5%
Medical Services with No Gaps 87.2% 92.4% 93.4% 94.1% 91% 90.8% 88.5% 76.9%
Industry Result 79.1% 89.5% 86.7% 89.2% 89.5% 84.4% 90.2% 84.2%
Medical Services with No or Known Gaps 97.4% 98.2% 99.1% 98.7% 98.8% 97.7% 97.9% 97.5%
Industry Result 90.5% 95.7% 95.1% 94.5% 96.6% 96.2% 96.7% 93.8%
General Treatment (extras) Covered 55.2% 53.8% 55.4% 56.5% 58.4% 55.6% 59.5% 52.2%
Industry Result 43.5% 50.8% 52.1% 54.2% 57% 57.5% 54.3% 58.8%
Private Hospital Agreements 5 97 78 52 24 22 5 2
Industry Maximum 6 97 78 57 27 24 9 2
Day Hospital Agreements 7 90 71 49 29 23 4 1
Industry Maximum 8 99 76 51 29 25 8 1
Share of PHIO complaints Compared to insurer's market share
Benefit Complaints - <0.5%
Service Complaints -
All Complaints 0.2%
Investigations 0.6%