High Claims Total $2.7billion

08 May 2010Media Releases

The Australian Health Insurance Association’s Annual High Claims Survey – hospital claims exceeding $10,000 – found that the number of high claims for 2009 increased by 4,000 (3.2%) and the cost of those high claims increased by $120 million (4.7% ) on the previous 12 months.

The total benefits paid for all high claims reached $2.7 billion, representing 31% of the total cost of benefits paid for hospital treatment during 2009. The AHIA annual survey includes data collected from 35 private health funds representing 99% of the private health insurance industry. Participating funds reported 134,956 claims where the benefit payment exceeded $10,000.

Of the 134,956 claims:
• 27 cost more than $200,000
• 271 cost more than $100,000
• 3,779 cost more than $50,000
• 14,600 cost more than $30,000
• 45,874 cost more than $20,000
• 89,172 cost between $10,000 and $20,000

The highest benefit paid was $439,626 for treatment of a patient with a developmental disorder of the bones and cartilage.

There were more than 6000 high claims for persons aged under 30 years, representing an increase of 29% on the previous year. High claims benefits paid for under 30’s totalled $110.5 million during 2009.

Of the high claims for the Under 30’s:
• 8 out of the top 30 high claims involved heart procedures
• 5 out of the top 30 high claims involved spinal procedures

AHIA CEO Dr Michael Armitage said the high claims survey demonstrated the contribution Private Health Funds made to the lives of individuals as well as Australia’s health care system.

The most recent Health Payments Index, published by the AHIA, shows that Private Health Insurance payments for the 12 month period to February 2010 shows a 7.9% increase or an annual increase in payments of +$792 million.

Dr Armitage said PHI Funds would inject an additional $1 billion into Australia’s health care system in 2010 bringing total expenditure on private health treatments to more than $12 billion.

* The Annual AHIA High Claims Survey (CY 2009) is attached.