Industry claims report on health insurance value

Private Healthcare Australia’s Annual High Claims Report, which Doctors’ Health Fund contributes data to, confirms health funds paid out 382,400 hospital claims exceeding $10,000 in 2021.

This was an increase during 2021 of 6.7% (an additional 24,025 claims), with total hospital benefits paid for these claims exceeding $7.8 billion (a 6.3% increase from 2020 and a 3% increase from pre-pandemic 2019).

PHA Chief Executive Dr Rachel David said the report demonstrated that private health insurance provides value to both young and older Australians, particularly in the current pandemic environment.

“The COVID-19 pandemic and long-term lockdowns have hit younger people extremely hard, as seen by the increase in mental health claims among this cohort. Similarly, claims for COVID-19 treatment continue to rise and while the average age is 65, more than 10% of COVID-related hospitalisations were for members under 30,” she said.

Claims exceeding $10,000 for mental health treatment among Australians under 30 have increased dramatically since the start of the COVID-19 pandemic.

In 2021 compared to pre-pandemic 2019:

• High cost claims for mental health treatment for members under 30 have increased by 13.7%, up $19.06M to $161.68M
• High cost claims for mental health treatment for members aged 20 to 30 have increased by 9.2%, up $10.5M to $128.2M
• Of these, the average length of stay in hospital for a mental health treatment episode of care was approximately 26 days
• 74% of mental health treatment for under 30s high claimants are females (a 4% increase from 2019)
• Severe depressive episode without psychotic symptoms (not postnatal-related) was the top hospitalisation reason for under 30s high claimants for mental health treatment in hospitals (comprising 17% of under 30s high-cost claims for mental health treatment in hospitals).

Claims for COVID-19 treatment during 2021 have also increased significantly and continue to do so. This includes any in-hospital treatment that may be required as a result of rare adverse reactions to COVID-19 vaccinations.

Since the start of the pandemic, there have been 4,751 COVID-19 confirmed hospitalisations funded by private health insurance (220 in 2020; 825 in 2021; 3,706 in 2022, to date). The average member age with confirmed COVID-19 hospitalisation funded by private health insurance is 65 years old, however 11% of hospitalisations were for members under 30.

• 19% (or 1 in 5 ) were high cost claims where total fund benefit payments exceeded $10,000.
• 8% were cases where the members’ hospitalisation was prolonged due to contracting COVID-19 while in hospital.

The highest benefit paid for COVID-19 confirmed hospitalisation in 2021 was $159,198. The average length of stay in hospital for the management of private patients with confirmed COVID-19 infection is 10 days.

View the full report here.

This article has been edited and was originally published by Private Healthcare Australia - privatehealthcareaustralia.org.au/high-claims-confirm-phi-value-for-australians-young-and-old/