Annual high claims report reveals rise in mental health treatment

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Private health insurers have reported a significant jump in the number of high claims by young Australians experiencing serious mental health issues.

Private Healthcare Australia has released its annual hospital high claims report for the year ending December 2020.

Hospital high claims are those where the benefit paid exceeds $10,000. In 2020, private health insurers paid out 358,375 hospital high claims. This was down 2.6 per cent on the previous year.

Of the 358,375 high claims, 13 cost more than $300,000, 69 more than $200,000 and 865 more than $100,000.

The highest benefit paid was $768,946 for the treatment of diverticulitis (inflammation or infection of abnormal pouches in the bowel wall) with perforation and abscess, requiring tracheostomy with ventilation. The patient was in hospital for over six months.

According to the report, the number of high claims for mental health treatment for people aged under 30 increased by 4.8 per cent with benefits paid rising to $146.5 million. One in five hospital claims for people aged under 30 was for mental health treatment. This is defined as the care of patients with psychiatric, mental, addiction or behavioural disorders.

The report says the average length of stay in a hospital for mental health treatment was around 26 days with 72 per cent of these high claims for females.

The significant increase in high claims for mental health treatment is set against a backdrop of the COVID-19 pandemic that has seen an overall reduction in hospital high claims.

Private Healthcare Australia CEO Dr Rachel David said the report also showed health fund members were using their private health insurance for COVID-19 hospital admissions and treatment.

Private health insurers also funded 206 hospitalisations caused by COVID-19. Of these cases, 52 were high claims where total fund benefit payments exceeded $10,000. The highest benefit paid for a COVID-19 hospitalisation was $110,706, where the patient spent almost three weeks in an intensive care unit, while the average length of stay in hospital for the management of patients with confirmed COVID-19 was 13.7 days.

“Of concern are recent media reports of hospital-acquired COVID-19 cases - there was some evidence of this in the high claims report - highlighting the need to prioritise staff vaccination and rapid testing in hospitals and health care environments to ensure patient safety,” said Dr David.