Private Healthcare Australia’s Annual High Claims Report confirms the value of private health insurance, with health funds paying out 382,400 hospital claims exceeding $10,000 in 2021.
This was an increase in the number of hospital high claims during 2021 of 6.7% (an additional 24,025 hospital high 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 PHI 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 claims for mental health treatment for members under 30 have increased by 953 claims to 7,925 claims (13.7% increase), up $19.06M to $161.68M (13.4% increase)
- High claims for mental health treatment for members aged 20 to 30 have increased by 529 claims to 6,270 claims (9.2% increase), up $10.5M to $128.2M (8.9% increase)
- For these young high claimants, the average length of stay in hospital for a mental health treatment episode of care was around 26 days
- 74% of mental health treatment under 30s high claimants are females (a 4 percentage points 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 (17% of under 30s high claims for mental health treatment in hospitals).
Claims for COVID-19 treatment during 2021 have also increased significantly and continue to do so.
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.
- 912 (1 in 5 or 19%) were high claims where total fund benefit payments exceeded $10,000.
- 358 (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.
The report is available at https://privatehealthcareaustralia.org.au/wp-content/uploads/PHA-Annual-High-Claims-2022-Report-FINAL.pdf
Media contact: Jen Eddy, 0439 240 755