2026 APHA Congress: Australia's private healthcare is Lost in Translation

The strongest message I took away from the APHA Congress in Adelaide was that private healthcare is becoming harder to explain, harder to afford and harder for patients to trust.

It reminded me of Lost in Translation.

Patients are Scarlett Johansson’s character: disoriented, trying to make sense of an unfamiliar system, surrounded by people who seem to understand the rules better than they do.

Doctors and specialists are Bill Murray. Familiar, trusted, likeable and, in the end, someone we want to believe is on the patient’s side. But also not perfect. Sometimes unclear. Sometimes caught up in the confusion. Sometimes failing to communicate as clearly as they could.

Health funds are the production crew speaking a language most people do not understand. Technically, there is communication happening. There are words, documents, policies, exclusions, product tiers and rebate rules. But for the person trying to navigate the system, too much meaning gets lost along the way. Suspiciously, the best dressed in the room…

That is increasingly how private healthcare feels for patients in Australia.

They are paying for cover. They are told they have choice. They are reassured that private health insurance gives them access, certainty and control. But when they actually need care, the language changes.

Suddenly they are dealing with exclusions, restrictions, gap payments, fund rules, hospital agreements, rebate limitations and out-of-pocket costs.

The words are technically there.

But the meaning is often lost.

The strongest message I took from the Congress was not that private healthcare is important. Most people in the room already knew that.

The clearer message was that private healthcare is becoming harder to explain, harder to afford and harder for patients to trust.

That matters because Australia does not have a spare health system sitting in reserve. Private hospitals play a critical role in elective surgery, acute mental health, maternity, rehabilitation and a large share of the care that helps keep pressure off public hospitals.

When private healthcare becomes less viable, less affordable or less accessible, the pressure does not disappear.

It shifts.

Usually, it shifts to patients, specialists, private hospitals and eventually the public system.

The patient is caught in the middle

The public debate often becomes a blame game.

Patients blame specialists when they receive an unexpected out-of-pocket bill. Specialists blame insurers and Medicare rebates that have not kept pace with the real cost of running a practice. Hospitals point to rising wages, workforce shortages and funding pressure. Insurers point to claims costs, utilisation and affordability.

There is truth in parts of each argument.

But from the patient’s perspective, the result is simple: they thought they were covered, and then discovered they were not.

That is the trust gap.

And the more I listened at the Congress, the more obvious it became that this trust gap is now one of the defining issues for private healthcare in Australia.

This was particularly clear in discussions around acute mental health, maternity and elective care.

Private healthcare is not a luxury add-on to the Australian health system. In many areas, it is core infrastructure. Private hospitals help reduce pressure on the public system, provide specialist capacity and support patients who would otherwise face even greater delays.

Acute mental health is one of the clearest examples. Even with significant unmet demand, private psychiatric hospitals continue to face viability pressures, under-utilised beds, workforce shortages and difficulty securing psychiatrists to admit patients.

That highlights one of the uncomfortable realities facing the sector.

Capacity can exist on paper, but still be inaccessible in practice.

Private maternity was also raised as a concern. If private maternity services decline, demand does not disappear. It shifts further into the public system.

That is why the sustainability of private healthcare matters to the whole health system, as much as it does to private hospitals, specialists and health funds.

Patients are consumers, even when healthcare is not an ordinary consumer market

Some clinicians dislike the word “consumer” in healthcare.

I understand why.

Patients are not buying shoes or booking a hotel. They are often making decisions under stress, pain, uncertainty and time pressure. Healthcare is personal. It is emotional. It is clinical. It is not a normal marketplace.

But when people are paying thousands of dollars a year in premiums, facing possible out-of-pocket costs, comparing providers online and trying to choose where to receive care, they are behaving like consumers whether the sector likes the language or not.

They want to know:

What am I covered for?

What will this cost me?

Who is available?

Why should I choose this specialist, hospital or service?

What happens if something changes?

At the moment, too many patients only get clear answers after something has gone wrong.

That is not good enough.

If private healthcare wants patients to make informed decisions, then patients need information they can actually use before they choose care, not after they receive a bill.

The health fund trust problem cannot be ignored

The most uncomfortable part of the debate is that insurers continue to sit in a powerful position.

They collect premiums. They influence what is covered. They negotiate with hospitals. They shape gap arrangements. They can promote cheaper products with more exclusions. And increasingly, some are moving closer to care delivery itself through vertical integration, preferred provider arrangements and no-gap models.

To be clear, no-gap care can be a very good thing.

For patients, the appeal is obvious. Greater certainty. Fewer unexpected bills. A clearer pathway into care. At a time when affordability is one of the biggest pressures in private healthcare, models that reduce or remove out-of-pocket costs should not be dismissed.

In fact, when done well, no-gap care can be one of the clearest examples of the system working in the patient’s favour.

But the sector is still right to ask questions.

If the organisation funding care also has growing influence over where care is delivered, who provides it and how the pathway is structured, the question becomes: how do we make sure affordability does not come at the expense of choice, transparency or clinical autonomy?

The patient’s interests must come first.

The doctor’s clinical judgement must be protected.

Hospitals need to remain viable.

And insurers need to be accountable for the value they are returning to patients and providers.

The issue is not that private health insurance has no role to play. It clearly does. Nor is the issue that no-gap care is inherently a problem. In many cases, it is exactly what patients want and need.

The issue is that insurers have become too comfortable speaking in a language patients do not understand.

Gold, Silver and Bronze tiers. Exclusions. Restrictions. Preferred provider arrangements. Known gaps. No gaps. Schedules. Benefits. Hospital agreements.

For the patient, the question is much simpler:

Am I covered, or not?

If the answer requires a phone call, a PDF, a policy document, a provider check and a surprise bill, then the system has failed to communicate.

And when the system fails to communicate, patients lose trust.

Specialists are not the villains

There is also a risk that the debate around out-of-pocket costs becomes too simplistic.

Specialist fees are visible. Insurer rebates, product exclusions and hospital contracting arrangements are often less visible.

That makes it easy for public frustration to land on the doctor, even when the actual cost gap is shaped by multiple parties.

Running a specialist practice is expensive. Staff, rent, indemnity insurance, equipment, technology, compliance, training and administration all cost money. Many specialists are small business owners operating in a highly regulated, high-risk environment.

That context matters.

It does not mean patients should be left in the dark. It does not mean every fee is beyond scrutiny. And it does not mean specialists have no responsibility to communicate more clearly.

But it does mean the conversation needs more balance.

Patients deserve transparency.

Specialists deserve context.

Hospitals deserve sustainable funding.

And insurers deserve far greater scrutiny for the value they are actually returning to patients and providers.

Specialists should not be defensive about being a premium option if they can explain the value behind that position: experience, outcomes, availability, subspecialty expertise, reputation, communication, hospital access and continuity of care.

In fact, transparency can become a strength.

There is nothing wrong with being more expensive than the specialist a few doors down if patients understand why.

Maybe you have deeper experience in a specific procedure.

Maybe you have stronger availability.

Maybe your reputation, outcomes, communication or care model gives patients more confidence.

Maybe patients are willing to pay more because they can see the value.

The problem is not being a premium option.

The problem is being a premium option without helping patients understand the value behind it.

What providers can do now

Reform is needed, but hospitals and specialists do not need to wait for reform before improving the patient experience.

There are practical things providers can do now.

Publish clearer information about fees, likely gaps and billing pathways. Explain what affects the final cost. Show which insurers you commonly work with. Make it easier for patients to understand what questions to ask their fund before admission. Provide plain-English content on common procedures. Make referral pathways easier for GPs. Show availability where possible. Build online trust through reputation, reviews, credentials and useful patient education.

This is not about turning healthcare into e-commerce.

It is about recognising that patients now search, compare and decide in a very different way.

This is most visible in areas such as IVF, maternity and orthopaedics, where patients are often highly motivated to research their options. But even in higher-acuity areas, where GP and specialist referrals still drive much of the patient flow, digital trust still matters.

Patients may not always choose their specialist in the same way they choose a hotel or restaurant.

But they still search names.

They still read reviews.

They still compare locations.

They still look for reassurance.

They still want to understand what happens next.

The providers that are easiest to understand will have an advantage.

Not because they are the cheapest.

Because they reduce uncertainty.

The opportunity for private healthcare

The future of private healthcare will not be secured by asking patients to tolerate more complexity.

It will be secured by making care easier to understand, easier to access and more financially predictable.

That means insurers need far greater accountability for the value they return to patients and providers. It means government needs to stop letting reform drift. It means hospitals need sustainable funding. It means specialists need to communicate their value more clearly. And it means patients need information they can actually use before they make decisions, not after they receive a bill.

My main takeaway from the 2026 APHA Congress was that private healthcare remains critical to Australia’s health system.

But critical does not mean untouchable.

If the sector wants to maintain trust, it has to confront the parts of the system that feel opaque, unfair or unpredictable to patients.

And right now, the biggest threat to trust is not that patients are asking more questions.

It is that too many of them are discovering the answers too late.

Let’s just hope the future of private healthcare does not become Her.

Joaquin Phoenix as the patient, falling in love with a beautifully designed health fund interface that says all the right things, right up until he needs to understand whether he is actually covered.

Because the answer to healthcare complexity is not more soothing language.

It is clarity.

What am I covered for?

What will this cost me?

Who can I see?

What happens if something changes?

Private healthcare does not need more fine print.

It needs more trust.

And trust starts with clarity.

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By Nathan Hill, Managing Director of Medico Digital APAC.