Private health insurers pay out record number of high claims

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Private Healthcare Australia has released its 2019 high claims data report revealing health funds paid 367,979 hospital claims where the benefit payment for the episode of care exceeded $10,000.

The organisation said this is an increase of 16,700 (4.8 per cent) high claims on the previous year.

Of the claims, 28 cost more than $300,000, 106 cost more than $200,000, 936 cost more than $100,000 and 12,643 cost more than $50,000 - over 350,000 claims cost between $10,000 and $30,000.

CEO Dr Rachel David said the updated report provides further evidence of the rising costs of healthcare.

“In the year 2019, total hospital benefits paid exceeded $7.57 billion, which is a 5.9% increase on the previous year. Health inflation continues to rise at levels substantially higher than general inflation," said Dr David.

"This is a reminder the health sector must work together to bring down the costs of healthcare and remove waste in the system to make private health insurance premiums more affordable for Australian consumers.”

The highest benefit paid in 2019 was $629,544 for heart valve disease, requiring replacement of the valve with a bioprosthesis (biological artificial valve implant). The patient was in hospital for four months.

Dr David said the report demonstrates the value of private health insurance for young people and particularly those needing mental health treatment.

“There were 19,455 hospital claims with benefits exceeding $10,000 for people aged under 30. This is an increase of 4.9% compared to the previous year and in part can be attributed to the rise in mental health claims by young Australians," she said.

The organisation said private cover pays benefits for many mental health treatments that are not readily available in the public system. The highest mental health claim paid out in 2019 was $192,658 for a young patient with a recurrent depressive disorder. 

For all mental health claims, over 30,000 Australians received more than $10,000 each in benefits – an increase of more than 42 per cent over the past four years.

Dr David said the report also reveals surgery for back pain is one of the highest costs to health funds.

“An ageing population and increasing rates of obesity are contributing to a surge in patients seeking treatment for back pain. There is much greater scope to fund earlier interventions for back pain as in many cases surgery is shutting the gate after the horse has bolted and is not effective at improving patient outcomes," she said.