Bupa calls for insurers to play a bigger role in primary care
25 Aug 2026
In a new discussion paper, the private health insurer said prevention and early intervention should play a bigger role as Australia faces growing demand from chronic diseases.
Under current rules, private health insurers generally cannot cover out-of-hospital medical services that attract a Medicare benefit. Bupa is calling for changes to the Private Health Insurance Act 2007 so insurers could support preventive health programs, early intervention, care coordination and chronic disease management.
The insurer said funding should be based on whether a service is clinically effective and provides value, rather than whether it takes place inside a hospital.
The proposal has raised concerns from the RACGP about how greater insurer involvement could affect patients and general practice.
Associate Professor Rashmi Sharma, Chair of the RACGP Expert Committee – Funding and Health System Reform, said the RACGP supports greater focus on prevention, early intervention and chronic disease care.
However, she said any expansion of private health insurers into primary care must protect universal access, equity and the role of Medicare.
The RACGP also wants any new funding or care arrangements to be GP-led, transparent and focused on patients rather than insurers' commercial interests.
Bupa already operates more than 30 GP clinics across Australia and has announced plans to acquire 68 GP clinics and three urgent care clinics from Partnered Health.
Its latest proposal would further expand insurer involvement in primary care by supporting care across prevention, early detection, treatment, ongoing management and referrals.
Bupa also wants better information sharing between insurers, GPs, specialists, allied health professionals, pharmacists and hospitals.
Associate Professor Sharma said reforms should make care easier to coordinate rather than create additional pathways for patients to navigate.
She said increased investment could improve access to preventive care, allied health services, care coordination and early intervention, but warned that patients could face confusion if multiple providers and funding arrangements become involved.
The RACGP also raised concerns that private health insurance customers could receive preferential access to general practice, potentially creating greater barriers for people without private cover.
Bupa's paper also proposes changes to Medicare, including expanding MyMedicare through patient-linked funding for people with chronic and complex health needs.
The proposal would involve participating practices changing internal payment arrangements to recognise GP clinical oversight and care coordination.
Bupa said the current fee-for-service approach does not adequately support prevention and coordinated care, particularly for people with complex and chronic conditions.
The insurer also proposed a mechanism that would allow GPs to seek brief advice from specialists without requiring a formal specialist consultation.
Bupa APAC CEO Nick Stone said Australia's health system needs to become more connected, preventive and focused on patients.
The RACGP, however, warned that greater involvement by insurers in delivering or coordinating primary care could affect continuity of care if appropriate safeguards are not put in place.
Associate Professor Sharma said some GPs already report that insurer-funded services are not well connected with care provided by patients' regular doctors.
She said adding another payer or care coordinator could increase complexity for general practice and patients.
Bupa calls for insurers to play a bigger role in primary care
Source: RACGP newsGP and Bupa discussion paper