High Claims Payments Hits Record High of $3.8 billion in 2011

07 May 2013Media Releases

Private Healthcare Australia’s annual survey of ‘high claims’ in 2011, found that private health funds paid 169,825 claims where the benefit payment for the episode of care was more than $10,000.

The benefits paid for all high claims in 2011 increased by 12% on the previous year, with total payments exceeding $3.8 billion. This represents 38% of benefits paid on behalf of members for hospital treatment during 2011.

Private Healthcare Australia’s Chief Executive, Dr Michael Armitage, said the data collected from 32 Health Funds represented 98.8% of the private health insurance industry in Australia and demonstrated the contribution PHI made to the lives of individuals, as well as Australia’s health care system.

The highest benefit paid during 2011 was $370,921 for the treatment of a patient with stomach cancer.

Of the 169,825 claims:

  • 31 cost more than $200,000
  • 362 cost more than $100,000
  • 5,061 cost more than $50,000
  • 16,632 cost more than $30,000
  • 42,454 cost more than $20,000
  • 105,325 cost between $10,000 and $20,000

Dr Armitage said the survey also highlighted the role of private health insurance in the lives of young Australians.

For privately insured Australians aged under 30, there were 9,235 claims with benefits exceeding $10,000, an increase on the previous year of 9.3% (701 claims).  Of these, 1,979 claims were for neonatal care provided to premature babies with a total cost of $43 million.

Benefits paid for all high claims over $10,000 for under 30s totalled $177 million in 2011.

Of the 9,235 claims:

  • The highest claim was for $165,364 for the treatment of lung inflammation following inhalation of food and vomit during a procedure.
  • 6 out of the Top 30 High Claims involved heart procedures.
  • 4 out of the Top 30 High Claims involved a spinal procedure.
  • 3 out of the Top 30 High Claims involved mental disorders

“Young people under the age of 30 often think that age precludes them from serious illness. This survey demonstrates that it is just as important for young Australians to plan for their healthcare needs”.

* The Private Healthcare Australia 2011 High Claims Survey is attached.

Further information:  Jen Eddy 02 62021000