There is some recent commentary on the value of private health insurance; particularly for young people. Other comments indicate that a Basic level of cover is all that is necessary. We have compiled some statistics that might be cause for reflection.   

Mental health
Of all Doctors' Health Fund admissions in the financial year, mental health-related admissions accounted for 7.5% and 6.3% of hospital benefits paid in the 2019 financial year.

The highest number of mental health admissions for women was in the 20-29 age band, where they accounted for 43.4% of all medical admissions among women in that age group. Conversely, men in that same age group accounted for 17.8% of admissions for psychiatric services.

psychiatric chart

Interestingly, the greatest number of admissions for mental health services for men was in the 40-49 age band, but it is still less than half that of women in their 20s.

“We are working hard to support our members in this important area. In addition to hospital and medical benefits, we have paid more than $500,000 in extras benefits on mental health services, which include psychology and counselling sessions,” says Peter Aroney, CEO of Doctors’ Health Fund.

Bones, joints and muscles
The highest number of admissions for 20 to 29-year-old males are for bone, joint and muscle-related conditions, which make up 16% of admissions in that age group. Procedures include, but are not limited to, joint reconstruction, joint replacement and rehabilitation. Factor this with the high rate of mental health treatments, and it’s evident that younger people do benefit from private health insurance.

“Private health insurance doesn’t just benefit older or high-risk people; our range of cover is designed for different life stages. Often people don’t see the true benefits or value of adequate cover until an incident occurs”, says Aroney.

High-Cost Claims
In the last financial year, we funded four individual admissions which cost more than $100,000 each.

The highest value claims we paid for a single hospital admission was $264,200 for heart and vascular issues. The patient suffered complications post-surgery, which required additional care and spent many days in hospital and ICU.

The second highest related to complications arising from a procedure to treat a member for gastrointestinal cancer which resulted in $137,100.

“As a community-based health fund, we only exist to support each other.  We are proud to have been able to support our members through these episodes; no-one plans to have complications after surgery but having cover with us meant they could focus on their recovery without the stress of financial burden.”


Other stats
As expected, we continue to see a high number of benefits paid to the 60-80 age group. The most commonly claimed treatments among our entire membership were gastrointestinal endoscopies with the highest number of episodes in the 60 to 69 cohort.

The second most common claim was for rehabilitation, which is often a result of recovering from surgery. 

For heart and vascular-related conditions, men are twice as likely to be admitted than women across all age groups, but it is particularly prevalent in 60 to 69-year-old males.

    And finally, our members on Prime Choice Gold and Top Cover Gold benefitted from pregnancy and birth-related cover which saw more than 750 new babies delivered last year.