High Claims top $5 billion in 2014

30 Mar 2015Media Releases

Private Healthcare Australia’s Annual Survey of High Claims in 2014 found that private health funds paid 247,515 claims where the benefit payment for the episode of care was more than $10,000.

This is an increase in the number of high claims on the previous reporting year of 5.4% with benefits paid exceeding $5.1 billion. This represents 39.7% of benefits paid out on behalf of members for hospital treatment during 2014.

PHA’s Annual High Claims Survey analyses the nature and magnitude of high claims met by health funds over the past 12 months and is collated using survey data from 31 Australian health funds which in total represent 99% of the private health insurance industry.

Chief Executive Dr Michael Armitage said the survey 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 further demonstrates the contribution private health insurance makes to the lives of individuals, as well as Australia’s broader healthcare system.

The highest benefit paid was $565,346 for treatment of a prematurely born infant.

Of the 247,515 claims:

  • 15 cost more than $300,000
  • 47 cost more than $200,000
  • 549 cost more than $100,000
  • 8,080 cost more than $50,000
  • 14,646 cost more than $30,000
  • 32,304 cost more than $20,000
  • 152,458 cost between $10,000 and $20,000

Highest Claim for Selected Groups

  • Cardiovascular disease – $372,529 for the treatment of mitral stenosis
  • Mental Health – $56,706 for the treatment of recurrent depression
  • Cancer – $368,484 for the treatment of cancer of the gallbladder
  • Diabetes – $173,226 for the treatment of type 2 diabetes mellitus with ketoacidosis

Click here to download the PHA Annual High Claims Survey 2015 report.