High Claims for mental health treatment peak during COVID pandemic

14 Aug 2021Media Releases

Private Healthcare Australia’s 2021 High Claims Report highlights the value of private health insurance in the current pandemic environment, particularly as claims for mental health treatment continue to increase.

PHA 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. All policies, regardless of whether they are Basic, Bronze, Silver or Gold, cover members for hospitalisation related to COVID-19.

PHA’s annual High Claims Report analyses the nature and magnitude of hospital treatment high claims (exceeding $10,000) paid by health funds over the 12 months ending December 2020.

In 2020, the private health insurance sector paid out on behalf of members 358,375 hospital claims where the benefit payment for the episode of care exceeded $10,000, a decrease of 2.6% on the previous 12 months.

Dr David said despite the slight reduction in the number of hospital high claims due to the deferral of some surgery as a result of the COVID-19 pandemic, mental health high claims among young Australians had increased significantly.

High claims for mental health treatment for members under 30 increased by 4.8% to 7,305 claims with benefits paid totalling $146.55M.

  • One in five hospital claims for PHI members under 30 was for the care of patients with psychiatric, mental, addiction or behavioural disorders.
  • High claims for mental health treatment for those aged 20 to 30 has increased by 2.4% to 5,879 claims, with benefits paid totalling $118.46M.
  • For these young high claimants, the average length of stay in hospital for their mental health treatment episode of care was around 26 days (0.85 months).
  • 72% of mental health treatment under 30s high claimants are females (2% increase from 2019).
  • Mental diseases and disorders is currently the top major diagnostic category for PHI female members aged up to 55 years of age.

There were 206 COVID-19 confirmed hospitalisations funded by private health insurance in 2020 (6% for members under the age of 30). Of these cases, 52 were high claims (25%) 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 ICU.
  • The average length of stay in hospital for the management of patients with confirmed COVID-19 infection is 13.7 days.
  • The average total fund benefit paid by private health insurance for a COVID-19 confirmed hospitalisation was $8,500 per episode of hospital care and treatment in 2020. To date, the cumulative total fund benefits paid for these hospitalisations is over $1.7M

“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.

The industry report highlights the value of private health insurance to members who have needed to access services during periods of sudden illness or accident or when an operation is required and demonstrates the contribution private health insurance makes to Australia’s broader healthcare system. The PHI claims ratio in 2020 increased to an average of 89 cents in the premium dollar, up from 87 cents in 2019.

PHA’s High Claims Report is available here.



Media contact: Jen Eddy, 0439 240 755


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