Australian Government, Australian Government Actuary

4. Financial management of the Run-Off Cover Scheme

4.1 2017 – 18 Cash Flow

4.1.1. Table 7 sets out the cash flow statement of the Notional Account for 2017-18.

Table 7: Cash flow statement of the Notional Account 2017-18

Net cashflow was $17.3 million over 2017-18. This was calculated from income of $24.4 million (i.e. support payments and notional interest) and expenses of $7.1 million (i.e. indemnity payments and administration cost).

4.2 Experience and Model

Comment on experience during 2017-18

4.2.1. ROCS indemnity payments have been relatively low in the past, although there have been three years where payments have exceeded $4.5m. We believe that it is reasonable to expect the upward trend to continue as the scheme matures. Last year, we projected $5.7m would be paid by DHS in 2017-18. The actual amount was $4.9m.

4.2.2. In relation to Scheme-eligible claims which had been notified at the time of the previous review (30 June 2017) but not yet paid, actuarial estimates of the corresponding ROC indemnity payments had a present value then of $14.3 million (excluding claims handling costs and discounted at 5 per cent per annum). In 2017-18, claim payments of about $2.1 million were made by MIIs/MDOs relating to these claims (based on industry data). All else being equal, this would suggest a residual figure at 30 June 2018 of about $12.8 million in today’s dollars. Updated industry estimates put this number at around $14.0 million (excluding 2017-18 notifications), which is slightly higher than expected. This indicates that that the industry estimates for claims notified at the time of the previous review have increased marginally from last year.

4.2.3. Based on input from industry actuaries, the previous report estimated the incurred-but-not-reported (IBNR) Run-Off Cover Scheme liability at 30 June 2017 as $43.1 million (excluding claims handling costs and discounted at 5 per cent per annum). Table 8 sets out the expected new notifications that were implied within that estimate, alongside the most recent industry actuarial estimates provided for this report. Note that the estimates have been calculated from projected cashflows discounted at 5 per cent per annum to the middle of each notification year. It shows that the estimates have not changed significantly from last year. The greatest change is for 2017-18, where the estimate has been updated based on the actual claims notified during the year.

Table 8: Expected new notifications (excluding CHE)

Implied within last year’s estimate was an expectation that approximately $5.5 million in new notifications would emerge during 2017-18, $6.2 million during 2018-19, $6.4 million during 2019-20, $6.8 million during 2020-21 and $7.2 million during 2021-22. The most recent industry actuarial estimates predict around $4.9 million for 2017-18, $6.0 million for 2018-19, $6.4 million for 2019-20, $6.8 million for 2020-21 and $7.3 million for 2021-22.

Changes to model and assumptions

4.2.4. Last year, we revised a range of assumptions in light of the NCPD data that we received in 2017. These assumptions still appear reasonable in light of the most recent data. We have not made any changes this year.

4.2.5. The only assumption change this year is a reduction in the long term discount rate from 6 per cent per annum to 5 per cent per annum. The chosen rate provides consistency with the rate adopted in a number of similar contexts and therefore is suitable from a whole of government perspective at 30 June 2018.

4.2.6. Appendix 4 sets out the main assumptions and describes the methodology that was used to estimate the liabilities at 30 June 2018. Appendix 5 describes the assumptions and methodology used to project future liabilities. Appendix 6 considers the effect of the High Cost Claims Scheme (HCCS). The applicable HCCS threshold has been changed from 1 July 2018 and our model has been adjusted accordingly.8

4.3 Results: Projected Run-Off Cover Indemnity Payments

4.3.1 This section sets out projections of ROC indemnity payments for the next ten 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. We have not applied any margin to the industry’s estimates of future cash flows as the data provided by the industry in late 2018 was broadly consistent with the trend implied in the past payments data provided by the DHS. The underlying assumptions and methodology are described in Appendices 4 and 5, with the calculations summarised in Table 21. Table 9 below sets out the projections, which are illustrated in Figure 4. The Scheme is not expected to become mature in a cash flow sense for a number of years. The payments projected below are in nominal dollars and have not been discounted to current dollar values.

4.3.2 While we have received the actual payments to the end of December 2018 from DHS, it is difficult to adjust the industry projection for the full year based on half years of actual payments given the lumpy nature of the ROC indemnity payments. The projected payment figure for 2018-19 does not appear inconsistent with the actual payments to the end of December 2018. We have therefore used the industry projection without adjustment. The projected indemnity payments include indirect costs associated with handling claims, referred to as indirect claims handling expenses (CHE).

Table 9: Projected Run-Off Cover indemnity payments (including CHE)

We project the indemnity payments to be $5.2 million in 2019 and gradually increase to $10.6 million in 2028.

(a) These projected payments do not include ongoing administration amounts payable to insurers under the ROC Claims and Administration Protocol which are different to CHE.

Figure 4: Historical and projected Run-Off Cover indemnity payments (including CHE)

This chart shows the historical and projected ROC indemnity payments (including CHE) in nominal dollars.  ROC indemnity payments have averaged around $3.4 million per year for the three years to 30 June 2018. They are projected to be $5.2 million for the year ending 30 June 2019 and will increase to $10.6 million for the year ending 30 June 2028.  The specific numbers are set out in Table 8.

4.4 Results: Liability at 30 June 2018 & Notional Account

4.4.1 The estimation of the Commonwealth’s liabilities under the Scheme is inherently imprecise. 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.

4.4.2 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.

4.4.3 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 (including associated insurer claims handling expenses) which relate to medical incidents which occurred before the effective date of valuation.

4.4.4 The Commonwealth’s liabilities under the scheme at 30 June 2018 are considered under the following categories:

  • Outstanding compliance costs as at 30 June this year;
  • Scheme eligible claims which had been notified at the time of the review and paid by the MIIs, but not yet recovered from DHS;
  • Scheme eligible claims which had been notified to the MIIs at the time of the review but not yet paid;
  • Incurred claims that have not yet been reported to the MIIs; and
  • Claims handling expenses.

4.4.5 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 ROC notional account (the Notional Account) is maintained.

4.4.6 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.

4.4.7 The Notional Account is credited with:

  • ROC support payments;
  • amounts to offset ROC indemnity payments which relate to medical practitioners who were eligible at the commencement of the scheme; and
  • notional interest.

4.4.8 Notional interest is credited to the Notional Account to ensure reasonable treatment of the time value of money since ROC support payments are received by DHS well in advance of any ROC indemnity payments being made by DHS. 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.

4.4.9 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. Since the commencement of ROC indemnity payments, effect has been given to this commitment by ensuring that the Notional Account is credited annually with amounts to offset any ROC indemnity payments which relate to medical practitioners who were eligible at the commencement of the Scheme.

4.4.10 The Notional Account is charged with:

  • ROC indemnity payments; and
  • Payments made under the ROC Claims and Administration Protocol.

4.4.11 The 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.

4.4.12 Appendix 2 provides more detail on claim amounts eligible under the Scheme.

4.4.13 Note that the Scheme ‘operates after’ the HCCS. The effect of the HCCS is described in detail in Appendix 6.

4.4.14 Table 10 describes how an eligible $1 million claim notified after 1 July 2018 would be funded9. The total amount paid of $1,050,000 comprises claim costs of $1 million and CHE of $50,000.

Table 10: Funding sources for a $1 million claim which is eligible for the Run-Off Cover Scheme

HCCS will cover $250,000. The total reimbursement under the Run-Off Cover Scheme will be $800,000 which includes $50,000 CHE.

4.4.15 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.

4.4.16 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 time horizon for funding the Scheme, it is appropriate. 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.

4.4.17 Table 11 below sets out the balance sheet of the Notional Account as at 30 June 2018.

Table 11: Balance sheet of the Notional Account as at 30 June 2018

The notional account had $248.8 million assets and $69.2 million liabilities as at 30 June 2018. The liabilities consisted of $2.1 million outstanding compliance costs, $3.0 million paid by MIIs but not yet recovered from Medicare Australia, $14.0 million notified to MIIs but not yet paid by them, $46.5 million incurred but not yet notified to MIIs and $3.6 million claims handling expenses.

(a) Based on actual and expected payments made by DHS in 2018/19 in relation to prior claim years. Excludes amounts that may be payable to Guild and Berkshire Hathaway.
(b) Based mainly on estimates provided in relation to claims/incidents notified to MIIs and MDOs by 30 June 2018.
(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).

4.4.18 The Notional Account at 30 June 2018 has disclosed an estimated notional surplus of about $180 million. 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. Based on the data provided by DHS, this amount could be up to $330 million as at 30 June 2018. Generally, the estimated surplus position should be regarded as highly uncertain.

4.5 Results: Projected Liabilities of the Scheme

4.5.1 Finally, it is appropriate to provide a benchmark projection of the liabilities of the Scheme. Future liabilities under the scheme are projected having regard to the annual rate at which future liabilities will accrue, the payment of claims and the interest that is required to accrue to the (discounted) reserves each year.

4.5.2 Table 12 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 have been discounted to the end of the relevant financial year but have not been discounted to give values in today’s terms. The projected liabilities are not directly comparable with the corresponding amounts presented in last year’s report. This is because last year’s figures were based on a different long term discount rate of 6 per cent per annum. Detailed actual versus expected analysis is contained in Appendix 4.

Table 12: Projected balance sheet liabilities of the Notional Account

The liability as at 30 June 2018 was estimated to be $69.2 million, and this number is expected to grow steadily to $116.2 million by30 June 2023. We estimated new accrual to be $9.6 million in 2018-19 and allowed this number to increase with inflation.

(a) ROC indemnity payments plus CHE only. Does not include liability in respect of outstanding compliance costs. Refer Appendix 4 for further information.

4.6 Actuarial management

4.6.1 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]

Guy Thorburn FIAA
Australian Government Actuary
30 April 2019


8 As announced by the Government on 19 December 2017 in the Mid-Year Economic and Fiscal Outlook 2016-17, the High Cost Claim Threshold has increased from $300,000 to $500,000 from 1 July 2018.

9 As announced by the Government on 19 December 2017 in the Mid-Year Economic and Fiscal Outlook 2016-17, the High Cost Claim Threshold has increased from $300,000 to $500,000 from 1 July 2018.