Australian Government, Australian Government Actuary

3. Data

3.1 Data collection

3.1.1. For the purpose of preparing this report, certain data were collected from the MIIs by the Department of Human Services (DHS) during late 2015 including:

  • details of practitioners who were identified as having become eligible for membership of the Scheme before 30 June 2015;
  • details of claims (including incidents) notified to MIIs and MDOs by 30 June 2015 which might eventually become eligible for reimbursement under the Scheme;
  • details of ROC support payments;3
  • actuarial estimates of that part of the future claims cost of medical incidents projected to be notified during the 2015-16 to 2018-19 financial years which is expected to be reimbursed under the Scheme; and
  • actuarial estimates of that part of the future claims cost of medical incidents occurring during 2015-16 which is expected to be reimbursed under the Scheme.

3.1.2. This report also utilises other data and information including that which was previously provided to DHS for the purpose of section 34ZW of the Medical Indemnity Act.

3.2 Data verification

3.2.1. The results in this report rely on information provided by MIIs. This information is regarded as the most suitable information available for the current purpose.

3.2.2. Steps were taken to ensure, as far as practicable, that the information provided was prepared on a basis suitable for the purpose. Despite this, it is not possible to guarantee that the information provided is free from material error. The information was not independently audited. As was the case in previous years, there were some notable disparities in the data provided. This means that figures and estimates provided in this report need to be treated with some caution.

3.2.3. Historically, MIIs/MDOs have not maintained data in a form which is directly amenable to ROC analysis. For example, it has not been possible to establish a comprehensive list of doctors who were eligible for the Scheme on 1 July 2004. This is not a criticism of the MIIs. It simply reflects that their business and information systems were not developed with a scheme like the Run-Off Cover Scheme in mind. However, in order to monitor the operation of the Scheme effectively, accurate and timely data is clearly important.

3.2.4. Certain information was sought from industry actuaries. Guidance was provided as to the nature of the data, calculations and information required. Discussions with industry actuaries were held to supplement the data provided.

3.2.5. A range of assumptions was used by industry actuaries. Although some significant assumptions differ by only a few percentage points between actuaries, substantially different estimates of Scheme costs are produced. This is indicative of the highly uncertain nature of estimates of the costs of the Scheme.

3.2.6. It is to be expected that many of the data issues encountered will diminish in time. Until data issues subside, Scheme projections will be subject not only to the considerable inherent uncertainty which surrounds medical indemnity insurance business, but also to additional uncertainty associated with the amount and quality of the available data.

3.2.7. In general, the results in this report blend estimates provided by industry actuaries with other actuarial estimates based on data provided by the MIIs and assumptions and models developed within this office.

3.3 Eligible practitioners

3.3.1. Practitioners performing private practice become eligible for the Scheme by means of permanent retirement at age 65 years or older, cessation of private practice for three years, death, permanent disability or maternity leave. In addition, practitioners who have worked under a subclass 422 (Medical Practitioner) or 457 (Business [Long Stay]) visa under the Migration Regulations 1994 become eligible for the Scheme when they have permanently ceased medical practice in Australia and ceased to reside in Australia.

3.3.2. Appendix 2 describes the test of eligibility for the Scheme and the process of issuing and notifying compulsory run-off cover to eligible practitioners. Eligible practitioners are entitled to receive notification of the terms and conditions of compulsory run-off cover from their MII. MIIs are also required to notify DHS of the details of the compulsory run-off cover provided.

3.3.3. There are inherent lags involved in notification of the details of eligible practitioners to DHS. As a result, it will be possible only to estimate the number of practitioners who have become eligible for the Scheme at any time. For example, there will often be a delay between the time that a practitioner becomes eligible for the Scheme and the time when the insurer becomes aware of this. More generally, it is also very possible that there will be circumstances where an insurer is unsure of the eligibility status of a practitioner indefinitely; for example, where a practitioner has not renewed their insurance for, say, three years. For all of these reasons, the numbers of eligible practitioners reported by insurers need to be treated with caution.

3.3.4. The number of practitioners eligible for the Scheme in this report is based on:

  • data provided to DHS by the medical indemnity industry relating to practitioners identified as having become eligible between 1 July 2004 and 30 June 2015; and
  • industry estimates of practitioners eligible for the Scheme as at 1 July 2004, provided for the purpose of the 2004-05 report.

3.3.5. We have relied largely on the eligibility data provided by the industry. For a small number of records the practitioner’s eligibility date provided was clearly not reasonable, and we have made adjustments accordingly. As has been the case in all previous reviews, data changes from year to year undermine the reliability of the information. Table 1 summarises the data provided by the industry after adjustments.

Table 1: Run-Off Cover Scheme eligible practitioners

Eligible from This year’s data (a) Last year’s data (a)
Start up (that is 1 July 2004) 2,112 2,112
2004-05 402 406
2005-06 571 578
2006-07 705 698
2007-08 804 802
2008-09 761 765
2009-10 807 805
2010-11 1,014 1,001
2011-12 1,010 1,006
2012-13 1,123 1,135
2013-14 1,570 1,559
2014-15 1,140 n/a
Total number of practitioners who became eligible for the Scheme before 30 June 2015 12,019 10,867

(a) Note that these numbers have not been reduced in relation to practitioners whose eligibility has subsequently ceased.

3.3.6. According to the data provided by the industry, 1,140 practitioners became eligible for cover under the Scheme during 2014-15. In our previous review we estimated that 1,224 practitioners would become eligible for cover during 2014-15.

3.3.7. Table 2 below illustrates the breakup of new entrants by reason of eligibility, based on the data provided by the MIIs. Also shown are the projected new entrants during 2015-16 from the population of practising at-risk doctors4 produced by our model.

Table 2: Run-Off Cover Scheme new entrants by reason of eligibility
  Industry data   Model
2004-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16
Retired 1016 270 273 430 441 455 609 552 488
Maternity 547 189 185 199 202 212 231 151 461
Permanent
disability
87 13 15 34 22 18 29 14 31
Died 369 84 94 96 94 107 89 68 114
Resigned 246 100 111 128 117 136 198 95 190
Other(a) 217 105 129 127 134 195 414 260 -
Total 2482 761 807 1014 1010 1123 1570 1140   1284

(a) Overseas trained doctors who had permanently ceased practice under a 422 or 457 visa.

3.3.8. We have not projected any new entrants in the ‘other’ category. Historically, practitioners in this category have paid very low premiums. Accordingly, we have assumed that medical negligence claims against them are likely to make an immaterial contribution to the Scheme costs.

3.4 Claims eligible for Run-Off Cover indemnity payments

3.4.1. MIIs and MDOs are entitled to reimbursement from the Australian Government for the costs of claims which:

  • are first notified to the MII or MDO on or after 1 July 2004;
  • relate to a practitioner who is eligible under the Scheme at the date of notification;5 and
  • meet the other requirements for ‘payable claims’.6

3.4.2. As at 30 June 2015, MIIs and MDOs had reported 434 medical incidents relating to eligible medical practitioners since the commencement of the Scheme and 215 of those have either led to a payment or have a case estimate7 attached to them.

3.4.3. Table 3 below illustrates the breakup of the reported incidents by the year in which the medical practitioner became eligible for ROCS, based on the data provided by the MIIs.

Table 3: Reported incidents by year of eligibility
Eligible from This year’s data(a) Last year’s data(a)
Start up (that is 1 July 2004) 41 40
2004-05 26 28
2005-06 33 35
2006-07 37 36
2007-08 23 24
2008-09 33 36
2009-10 79 81
2010-11 40 45
2011-12 24 28
2012-13 30 26
2013-14 27 14
2014-15 14 n/a
Total number of reported incidents
at 30 June 2014
393 381

(a) The doctor’s ROCS eligibility date was missing for 27 incidents.
(b) The doctor’s ROCS eligibility date was missing for 30 incidents.

3.5 Run-Off Cover indemnity payments

3.5.1. ROC indemnity payments are the payments made by the Australian Government to MDOs and MIIs as reimbursement of the costs of eligible claims.

3.5.2. The Scheme also provides for payments in respect of compliance costs and indirect claims handling expenses under the ROC Claims and Administration Protocol (section 34ZN of the Medical Indemnity Act).

3.5.3. ROC indemnity payments totalling $21.8 million (including indirect claims handling expenses) had been made up to 30 June 2015, all of them since 1 July 2007. Specifically during 2014-15, $5.86 million in ROC indemnity payments were made which included a $2 million payment for a single claim.

3.5.4. $11.5 million in compliance cost payments have been made to MIIs up to 30 June 2015, and based on applications received by DHS we have estimated that a further $0.7 million relating to periods prior to 30 June 2015 is payable.

3.5.5. The Commonwealth’s own administration costs are Budget-funded and so are not considered in this report.

3.6 Run-Off Cover support payments

3.6.1. ROC support payments are paid to DHS in the form of an annual lump sum imposed as a tax on each MII from 1 July 2004 under the MI ROCSPA.

3.6.2. The amount of ROC support payments is calculated using a method set out in the MI ROCSPA. Appendix 1 describes the calculation in detail. Very briefly, it is based on:

Applicable rate × (premium income less taxes and charges) ÷ (1 + applicable rate).

3.6.3. In 2014-15, the applicable rate was 5 per cent for all insurers.

3.6.4. Table 4 below summarises the ROC support payments received during the 2014-15 financial year. The total amount increased slightly from that received during the 2013-14 financial year. This was consistent with a slight increase in total medical indemnity premiums paid by practitioners during 2014-15. Some MIIs continue to collect membership fees in addition to medical indemnity premiums. In total, the amount of membership fees collected represents around 11 per cent of the amount of medical indemnity premiums collected across the industry. ROC support payments are not payable on membership fees.

Table 4: Run-Off Cover support payments<
ROC support payments ($’m)
Paid 30 June 2014 Paid 30 June 2013
AVANT 8.338 8.271
MDANI 2.607 2.624
MIGA 2.183 2.115
MIPSi 1.613 1.617
Total 14.739 14.627

3.6.5. In order to provide full transparency for practitioners, MIIs are required to attribute ROC support payments to individual policyholders. Each premium notice specifies the amount that has been included in the policyholder’s invoice to meet the MII’s ROC support payment obligations. All amounts are reported to DHS, which maintains a record of each practitioner’s total run-off cover credit. Interest is applied to this balance annually at the short term bond rate in accordance with section 34ZS of the Medical Indemnity Act.

3.6.6. Part 2, Division 2B, Subdivision E of the Medical Indemnity Act provides for certain payments, should the Scheme ever be wound up without alternative arrangements being put in place. Thus, doctors who were still practising at the time of the wind up of the Scheme would be entitled to have an amount not exceeding their total run-off cover credit paid to their nominated medical indemnity provider. Practitioners who were eligible for the Scheme at the time of its wind up would not be entitled to any refund but would continue to be covered for any future claims that might emerge.

3.6.7 Figure 2 below summarises the contribution to ROC support payments by age of practitioner. Note that age and gender were not available for a minority of doctors. The chart is based only on practitioners who paid at least $1,700 in respect of both medical indemnity premium (net of discounts and loadings) and membership fees during 2014-15. We refer to these practitioners as ‘at-risk doctors’. The proportion of ROC support payments is greater than the proportion of practitioners for doctors aged between 40 and 55, and the proportions are similar for doctors aged between 60 and 70. The chart also reflects the low level of premiums for doctors aged in their 20s and 30s and for doctors over age 70 who may tend to wind down their practice hours and possibly perform fewer risky medical procedures (for example, surgery) as they reach more advanced ages.

Figure 2: Contribution to Run-Off Cover support payments by age

Figure 2: Contribution to Run-Off Cover support payments by age.This chart shows that the proportion of ROC support payments is greater than the proportion of ‘at-risk’ practitioners aged between 40 and 50.  The proportions are similar for doctors aged between 50 and 70.  For all other ages, the proportion of ROC support payments is slightly lower than the proportion of practitioners.

3.6.8. Figure 3 below summarises the contribution to ROC support payments by area of specialty. Specialty codes were not available in relation to a small minority of doctors. Similar to Figure 2, this chart only includes ‘at-risk’ doctors.

3.6.9. Medical indemnity insurance premiums tend to be risk-based. Thus, practitioners operating in higher risk areas of specialty are likely to incur the highest premiums and, accordingly, the highest ROC support payment liabilities. The largest ROC support payments are for obstetricians, gynaecologists, neurosurgeons, cosmetic/plastic/reconstructive surgeons, orthopaedic surgeons, and general surgeons. General practitioners — non-procedural have the smallest average ROC support payments. Note that most medical practitioners not otherwise classified (including interns, trainees and hospital indemnified doctors) are not shown in this chart as they are not included in the ‘at-risk’ group.

Figure 3: Contribution to Run-Off Cover support payments by specialisation

Figure 3: Contribution to Run-Off Cover support payments by specialisation.This chart shows that practitioners in higher risk specialties incur the largest ROC support payments.  For example, obstetricians incur around 11 per cent of all ROCS support payments while comprising slightly less than 2 per cent of the ‘at-risk’ practitioner population.  Conversely, the less risky areas of specialty incur the lowest ROCS support payments.  For example, general practitioners (non-procedural) incur less than a quarter of ROCS support payments while comprising around half of the ‘at-risk’ practitioner population.  


3 A database of ROC support payments is maintained by DHS.

4 At-risk practitioners are defined in paragraph A.4.14.

5 Refer paragraph A.2.1.

6 Refer paragraph A.3.2.

7 Estimate of likely cost to the insurer.