A recent report by Private Healthcare Australia (PHA) has revealed that Australian health insurers paid out a record A$9.4 billion in “high claims” for hospital treatment exceeding A$10,000 in 2024. This represents a 10% increase from the previous year, with 453,259 high claims made in 2024. These high claims accounted for over 50% of all hospital benefits paid by health insurers in 2024. The report highlights a significant increase in mental health hospital high claims for members aged 65 and older, with a 13% increase in claims and A$147.7 million in benefits paid.
The data also shows that one-in-three hospital high claims for health fund members aged 18 to 30 were for mental health treatment, with 70% of these claims being for female patients. The average length of stay in hospital for these patients was 26 days. Additionally, the report reveals that over 1,000 people were hospitalised with serious conditions that resulted in payments of more than A$100,000 each, with conditions including coronary artery disease, severe infections, and cancers.
The highest benefit paid was A$697,267 for the treatment of severe mitral valve disease with a heart valve replacement. PHA CEO Dr. Rachel David noted that the record payout by health funds highlights the critical role of private health insurance in providing essential care to Australians, including infants and young people receiving mental health treatment. The report suggests that private health insurance is taking pressure off the public health system, allowing more Australians to access the care they need when they need it. This is reflected in the growing membership of health insurance in Australia. Overall, the report underscores the importance of private health insurance in supporting the healthcare needs of Australians.