4. Financial management of the Run-Off Cover Scheme
4.1 Future liabilities of the Run-Off Cover Scheme
4.1.1 The estimation of the Commonwealth’s liabilities under the Run-Off Cover Scheme in future years is an inherently imprecise process. The operation of the Scheme is likely to be characterised by a small number of claims of highly variable size. It is not possible to predict the costs of the Scheme with a high level of confidence. For example, the presence of a single very large claim in any given year could have a substantial effect on the total amount of ROC indemnity payments for that year.
4.1.2 The liabilities of the Scheme could be measured in a number of ways. It is normal for insurance-type liabilities to be measured on either a ‘notified’ or an ‘occurrence’ basis. On a notified basis, new liabilities would accrue to the Scheme as new claims were notified. On an occurrence basis, new liabilities would accrue to the Scheme at the time of the occurrence of the medical incidents which were expected to give rise to medical indemnity claims which would attract a ROC indemnity payment.
4.1.3 Under the occurrence model, liabilities are recognised more quickly than under the notified model. The occurrence model is more consistent with the notion that the Scheme is ongoing. Accordingly, the occurrence model has been adopted for this report. The liabilities of the Scheme are therefore taken as the present value of future ROC indemnity payments (plus associated insurer claims handling expenses) which relate to medical incidents which occurred before the effective date of valuation.
Comment on experience during 2007-08
4.1.4 In any actuarial investigation it is appropriate to compare the emerging experience with that previously projected. This analysis informs the assumption setting process for the current investigation.
4.1.5 Based on input from industry actuaries, the previous report estimated the incurred-but-not-reported (IBNR) Run-Off Cover Scheme liability at 30 June 2007 as $43.7 million. Implied within that estimate was an expectation that approximately $5.3 million in new notifications would emerge during 2007-08. In fact, the most recent actuarial estimates suggest $2.3 million in new notifications for 2007-08. The new claim experience for 2007-08 continues to be lighter than expected.
4.1.6 In relation to Scheme-eligible claims which had been notified at the time of the previous review (30 June 2007), actuarial estimates of the corresponding ROC indemnity payments had a present value then of $3.9 million. Since then, claim payments of about $0.2 million have been made by MIIs/MDOs. All else being equal, this would suggest a residual figure at 30 June 2008 of about $3.7 million. Up to date actuarial estimates put this number at around $2.7 million (excluding 2007-08 notifications). However since the numbers are small it would be inappropriate to draw strong conclusions based on them.
4.1.7 As noted earlier, the main area of emerging experience that has resulted in reframing the assumption set for this investigation has been the reported new entrant experience. Changes to assumptions are discussed below.
Changes to assumptions
4.1.8 We have made some changes to our assumptions for this investigation. Retirement, resignation, death and disability decrement assumptions have all been reduced to bring them somewhat more into line with reported experience.
4.1.9 The changes to the assumptions are subjective and it is important to note that our models continue to project higher numbers of eligible practitioners and more claims than have been reported by industry to date.
4.1.10 The remaining demographic and experience assumptions remain largely as they were for the previous investigation. We have not adjusted our assumptions in relation to claim reporting patterns. Based on the available data, it is conceivable that the average delay between incident and notification may be shorter than that implied in our model. It is certainly possible that the notification delay may have shortened in the claims made environment, and given tort law reforms. However, there is insufficient evidence available to justify shortening the assumed pattern. Moreover, a significant part of the Scheme accrued liability relates to ‘very old’ incidents, and would not be affected by any recent changes in reporting behaviour. Similarly, we have not altered our assumptions regarding overall claim frequency. We have retained our assumption regarding base claim size distribution.
4.1.11 The combined effect of the changes to our assumptions is a reduction of our estimate of the scheme accrual of 23 per cent.
4.1.12 We have altered our approach to assessing the IBNR liability. Specifically, we have started with the industry actuarial estimates and made two adjustments. Firstly, we have adjusted the estimates made in respect of two outlier pools of claims to bring them into line with the average across all the pools. Secondly, we have added a (subjective) margin of 25 per cent to the total in order to bring the IBNR estimates broadly into line with the estimate of new accrual that our model produces.
4.1.13 Appendix 4 sets out the main assumptions and describes the methodology that was used to estimate the liabilities. Appendix 5 looks at the effect of the High Cost Claims Scheme.
Projected ROC indemnity payments
4.1.14 This section sets out projections of ROC indemnity payments for the next 10 financial years. For the reasons described above, the projections should be regarded as indicative only. The data issues referred to earlier in this report also contribute to the uncertainty. The underlying assumptions and methodology are described in Appendix 4, with the calculations summarised in Table 15. Table 4 below sets out the projections, which are illustrated in Figure 4. The Scheme is not expected to become mature in a cashflow sense for many years. The payments projected below are in nominal dollars and have not been discounted to current dollar values.
4.1.15 The projected payment figure for 2008-09 assumes that all ROC indemnity payments which are ‘due’ at 30 June 2008 (that is which relate to claim payments already made by MIIs/MDOs) will be made during 2008-09. More generally, other ROC indemnity payments are assumed to be made at the same time as the corresponding claim payment. The estimates include indirect costs associated with handling claims, referred to as indirect claims handling expenses (CHE) (see 4.2.8 below).
Table 4: Projected ROC indemnity payments plus CHE
| Year ending 30 June | Projected ROC indemnity payments plus CHE $’000(a) |
|
|---|---|---|
| 2009 | 2,940 | |
| 2010 | 2,165 | |
| 2011 | 3,007 | |
| 2012 | 3,915 | |
| 2013 | 4,739 | |
| 2014 | 5,525 | |
| 2015 | 6,596 | |
| 2016 | 7,599 | |
| 2017 | 8,726 | |
| 2018 | 10,002 |
(a) These projected payments do not include administration amounts payable under the ROC Claims and Administration Protocol.
Figure 4: Projected ROC indemnity payments plus CHE
4.2 Notional Account
4.2.1 The Scheme must be managed over a long time frame. As discussed previously, ROC indemnity payments are likely to be ‘lumpy’ in nature and immature in size for some years. ROC support payments will be received well in advance of ROC indemnity payments. As a result of the payment timing mismatch and the expected volatility in the ROC indemnity payment pattern, it is appropriate to have a system which enables proper tracking of the financial flows over time. Accordingly, a Run-Off Cover Scheme notional account (the Notional Account) is maintained.
4.2.2 It is important to appreciate that the Notional Account is not an official Government account. Rather, it is a device established for the sole purpose of facilitating equity between practitioners and other taxpayers.
4.2.3 The Notional Account is credited with:
- ROC support payments;
- Amounts to offset ROC indemnity payments which relate to doctors who were eligible at the commencement of the scheme; and
- notional interest.
4.2.4 Notional interest is credited to the Notional Account to ensure that practitioners derive the proper benefit of the time value of money since ROC support payments are received by Medicare Australia well in advance of any ROC indemnity payments being made by Medicare Australia. Notional interest is applied at the short term bond rate for consistency with section 34ZS of the Medical Indemnity Act which requires interest at the short term bond rate to be applied to the total run-off cover credit balances of individual practitioners.
4.2.5 On establishment of the Scheme, the Government announced that it would fund the opening liability that was attributable to practitioners who were already eligible for cover under the Scheme at the time of its commencement. Now that ROC indemnity payments have commenced, effect is given to this commitment by ensuring that the Notional Account is credited with amounts which offset any ROC indemnity payments which relate to doctors who were eligible at the commencement of the scheme.
4.2.6 The Notional Account is charged with:
- ROC indemnity payments; and
- payments made under the ROC Claims and Administration Protocol.
4.2.7 The Run-Off Cover Scheme ‘operates after’ the High Cost Claims Scheme (HCCS). The HCCS meets 50 per cent of the excess above $300,000 of the cost of individual large claims. For example, for a claim which costs $1 million, the HCCS will pick up:
50 per cent × ($1,000,000 — $300,000) = $350,000
4.2.8 The Run-Off Cover Scheme will also pay an amount to a MII or MDO to cover the indirect costs associated with handling claims, referred to as indirect claims handling expenses (CHE). The Scheme pays 5 per cent of the cost of each claim to cover CHE. Table 5 below describes how an eligible $1 million claim would be funded. The total amount paid of $1,050,000 includes claim costs of $1 million and CHE of $50,000.
Table 5: Funding sources for a $1 million claim which is eligible for the Run-Off Cover Scheme
| Funding source | Amount |
|---|---|
| HCCS | $350,000 |
| ROC indemnity payment (direct claim costs) | $650,000 |
| Run-Off Cover Scheme CHE (5 per cent × $1 million) | $50,000 |
| Run-Off Cover Scheme (total) | $700,000 |
4.2.9 Appendix 3 provides more detail on claim amounts eligible under the Run-Off Cover Scheme.
4.2.10 As noted earlier, the Medical Indemnity Act provides for payment of a practitioner’s total run-off cover credit, should the Scheme ever be wound up without alternative arrangements being put in place. Thus, in this event, a large part of the accumulated ROC support payment balance would become a liability of the Scheme. At the same time, since the Scheme liabilities are being measured on an occurrence basis, some of the liabilities of the Scheme would be released, partially offsetting this impact. However, for the purpose of this report, the Scheme has been assumed to be ongoing and the whole amount of the accumulated ROC support payments has been taken to be available to meet relevant ROC indemnity payments.
4.2.11 The liability estimates given in this report are central estimates. In broad terms, this means that they are intended to be equally likely to be too high or too low. In particular, it is not intended that the liability estimates contain any margin for risk. Funding considerations for the Scheme are not the same as for private sector insurance arrangements. The objective here is to manage the funding over the long term. Since substantial volatility in the liability estimates is likely from time to time, periods of surplus and periods of deficit in the Notional Account might be expected. However, given the long funding time horizon that is appropriate for the Scheme, a short term deficit in the Notional Account is not a cause for concern. As a result of this, there is no strong reason to maintain a risk margin in the liability estimates.
4.2.12 Table 6 below sets out the cashflow statement of the Notional Account for 2007-08.
Table 6: Cashflow statement of the Notional Account 2007-08
4.2.13 Table 7 below sets out the balance sheet of the Notional Account as at 30 June 2008.
Table 7: Balance sheet of the Notional Account as at 30 June 2008
(a) Estimated amount payable under the ROC Claims and Administration Protocol in respect of AMIL’s calendar year 2007, PIICA’s 2007/08 costs and MIPS’s 2007/08 costs.
(b) Based on estimates provided in relation to claims/incidents notified to MIIs and MDOs by 30 June 2008.
(c) Based mainly on estimates provided by industry actuaries.
(d) Based on estimates provided by industry actuaries and models developed within this office.
(e) Based on 5 per cent of ‘grossed up’ ROC indemnity payments (to allow for the impact of the HCCS).
4.2.14 The Notional Account at 30 June 2008 has disclosed an estimated surplus of about $46 million. Some changes have been made to the preparation of the Notional Account balance sheet, as follows. Firstly, now that ROC indemnity payments have commenced, in order to give practical effect to the Government’s commitment to fund the opening liability, ROC indemnity payments have been split between payments in respect of doctors eligible at and after start-up of the ROC Scheme. Importantly, payments in respect of doctors eligible at start-up are offset by a notional cash injection into the Notional Account. This ensures that the Notional Account is not being charged for these payments in net terms. It also permits accurate monitoring, over time, of the value of the Government commitment. Since this can now be done transparently, the Government commitment item has now been removed from the Notional Account balance sheet. Note that the practical effect of this is that the Government commitment is now being accounted for on a cash basis in the cashflow statement as ROC indemnity payments are made. Secondly, the receivable in respect of Avant’s ex-AMIL policyholders has been removed from the balance sheet, with the result that the assets are now presented consistently on a receipts basis. Note again that no account has been taken for possible payments to practitioners under Subdivision E of the Medical Indemnity Act, should the Scheme be wound up without alternative arrangements being put in place. Generally, the estimated surplus position should be regarded as highly uncertain.
4.2.15 Finally, it is appropriate to provide a benchmark projection of the liabilities of the Scheme. Table 8 below sets out estimates of the liabilities of the Notional Account at the end of each of the next five financial years. The purpose is to illustrate the short term development of the Scheme. There is very substantial uncertainty in these estimates. The numbers shown are in nominal dollars and have not been discounted to give values in today’s terms.
Table 8: Projected balance sheet liabilities of the Notional Account
| Year ending 30 June | Liability ($’000)(a) | New accrual ($’000)(a) | Interest cost ($’000) | Payments ($’000)(a) |
|---|---|---|---|---|
| 2008 | 44,300 | - | - | - |
| 2009 | 55,717 | 11,119 | 3,237 | 2,940 |
| 2010 | 69,382 | 11,842 | 3,989 | 2,165 |
| 2011 | 83,817 | 12,612 | 4,829 | 3,007 |
| 2012 | 99,051 | 13,342 | 5,717 | 3,915 |
| 2013 | 115,276 | 14,305 | 6.659 | 4,739 |
(a) ROC indemnity payments plus CHE only. Does not include liability in respect of outstanding compliance costs. Refer Appendix 4 for further information.
4.3 Actuarial management
4.3.1 It is appropriate that the Scheme be subject to ongoing actuarial management.
4.3.2 Regular review of the costs and notional assets of the Scheme will allow the ROC support payment rate to be adjusted from time to time, if necessary. Consideration of that rate is beyond the scope of this report. This report has described a framework for the valuation of Scheme liabilities and established the Notional Account. It is intended that the valuation and accounting framework be applied at each future annual review of the Scheme.
SIGNED
Peter Martin FIAA
Australian Government Actuary
1 March 2009
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