Report Highlights the Value of Private Health Insurance for Young Australians

04 Jul 2017Media Releases

The value of Private Healthcare Insurance, particularly for younger Australians, was highlighted today with the release of Private Healthcare Australia’s Annual Survey Report of High Claims. (Click here to download the PHA Annual High Claims Survey 2016 report)

Health funds paid more than $6.4 billion in benefits for individual claims (for which the benefit payment was over $10,000) during 2016, representing an increase of 6.7% compared to 2015. Nearly half of all payments for hospital treatment by Australian health funds (45%) are now for claims where the benefit payment for the episode of care was more than $10,000.

PHA’s Annual High Claims Survey analyses the nature and magnitude of high claims paid by health funds over the 12 months to December 2016 and is collated using survey data from 33 health funds representing 100% of the private health insurance industry. In total health funds paid out on behalf of members 311,692 claims where the benefit payment for the episode of care was more than $10,000, the highest benefit paid being $406,566 for pancreatic cancer treatment.

PHA Chief Executive Dr Rachel David said the report highlights the value of private health insurance to members who have needed to access services during periods of sudden illness or when surgery is required, and demonstrates the contribution private health insurance makes to the lives of individuals, as well as Australia’s broader healthcare system.

“The report emphasises the importance of health fund membership for young Australians, with more than 16,000 high claims (benefits exceeding $10,000) paid for members under the age of 30 during 2016.This was an increase on the previous year of 858 claims (+5.6%).

“Many of these episodes involved hospital stays of more than 100 days for young Australians suffering from mental health issues, cancer and other conditions. Young people often think they’re invincible, but this data shows private health insurance is as important for those aged under 30 as it is for older Australians. It can be very difficult to get long-term treatment for conditions like PTSD and eating disorders in the public hospital system. Younger people who develop these conditions, or their families, can find themselves out of pocket by thousands of dollars if they don’t have private health insurance.”

Private health insurance is a critical element of Australia’s health care system. PHI pays for close to two thirds of non-emergency surgery in Australia, 90% of day admissions for mental health care and 50% of all mental health admissions, 70% of joint replacements, 60% of chemotherapy and 88% of retinal procedures take place in the private health sector.

More than 13.5 million Australians hold PHI and over half of those have disposable incomes under $50,000 per annum. 84% of people believe that they get value for money from their private health insurance. One of the main reasons for this is peace of mind as well as choice of doctor, choice of hospital, and timing of medical treatment.

Funds paid a record $19 billion in benefits in 2015-16, which will increase to $20 billion in 2016-17. For every dollar paid towards health insurance premiums, funds on average return 86 cents to the consumer in the form of healthcare benefit payments or claims reimbursements in 2015-16.This compares with 66c for general insurance in 2015-16.


Click here to download the PHA Annual High Claims Survey 2016 report.


Media contact: Jen Eddy 0439240755