New report highlights hospital benefit increase

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A new report has revealed private health insurers paid more than $7.14 billion in benefits for individual hospital claims where the benefit payment exceeded $10,000 during 2018.

The outcome represents an increase of 4.8 per cent compared to 2017 - with nearly half of all payments for hospital treatment by health funds (47 per cent or 351,279 claims) for claims where the benefit for the episode of care was more than $10,000. 

Private Healthcare Australia’s Annual Hospital High Claims 2019 Report analyses the nature and magnitude of high claims paid by health funds over the 12 months to December 2018. It is collated using data from 37 health funds representing 100 per cent of the private health insurance industry.

The report says the highest benefit paid was $531,777 for an 11.8 months hospital stay for knee arthrodesis. 

Private Healthcare Australia chief executive Dr Rachel David said, “The report emphasises the importance of health fund membership for young Australians, with more than 18,500 high claims (benefits exceeding $10,000) paid for members under the age of 30 during 2018. This was an increase on the previous year of nearly 1,400 hospital claims (+8.1%)."

Dr David continued, “Some of these episodes involved hospital stays of more than 100 days for young Australians suffering from mental and behavioural disorders, cancer, stroke and other conditions.

"Young people often think they’re invincible, but this data shows private health insurance is as important for those aged under 30 as it is for older Australians.

"It can be very difficult to get long-term treatment for conditions like PTSD, severe depression, schizophrenia, anxiety, alcohol and drug use disorder, eating disorders and chronic back pain in the public hospital system. Younger people who develop these conditions, or their families, can find themselves out of pocket by thousands of dollars if they don’t have private health insurance.”

Private health insurance currently pays for close to two-thirds of non-emergency surgery in Australia, 67 per cent of same-day admissions for mental health treatment and 53 per cent of all mental health care admissions, 57 per cent of joint replacements, 57 per cent of chemotherapy and 75 per cent of retinal procedures.

Health insurers paid a record $20.8 billion in benefits in 2018.