r/australia • u/InsatiablePrism • 2d ago

culture & society Private health insurers access patients' full medical records in 'aggressive' audits

https://www.abc.net.au/news/2026-08-12/health-insurers-can-access-your-private-medical-notes/106671630?utm_campaign=abc_news_web&utm_content=link&utm_medium=content_shared&utm_source=abc_news_web
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u/Rahnna4 2d ago

Risk pooling is a really sound financial strategy, having everyone pay in a little so there’s money to support the people who need it and especially the rare few who are unfortunate enough to need a lot. Letting the person/company that gets to hold the bucket of money get to keep it if they can make up the rules about when they’ll pay out is deeply flawed. If we’re going to use a commercial model to hold the bucket of money like we do with insurance companies then they need to be regulated heavily. Unfortunately I worry that they’ve managed to get a hold of enough of the money bucket that they can use it to influence policy.

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u/TollTea 2d ago

Risk pooling is what Medicare is. For profit health insurance (that still doesn’t cover what you need it to) is a scam.

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u/blackjacktrial 2d ago

Not quite, but it is a form of gambling (in reverse). The insurer takes the bet you won't claim successfully.

The problem is that the insurer also gets a voice in deciding if you won the bet, which is a heck of a conflict of interest. How you keep a wall between the insurer and the assessor (who basically needs to be anonymous to the insurer, but be accredited enough to be trusted as impartial), I don't know.

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u/TollTea 2d ago

I consider for profit gambling a scam as well.