The Australian Health Insurance Association’s Annual High Claims Survey has found that the number of “High Claims” – claims exceeding $10,000 – increased in 2008 by 11.6 percent on the previous year.

The cost of all High Claims in 2008 increased by 18% compared with the previous year, with benefits paid exceeding $2.6 billion. This represented 33% of the benefits paid out on behalf of members for hospital treatment during 2008.

AHIA Chief Executive Officer, Hon. Dr Michael Armitage, said the data collected from 34 health funds which represented 97% of the private health insurance industry, demonstrated the contribution private health insurance made to the lives of individuals, as well as Australia’s broader health care system.

“The highest benefit paid during 2008 was $630,400 for intensive care treatment for a patient with abdominal sepsis following surgery,” he said.

Participating funds returned 130,829 claims where the benefit payment for the episode of care was more than $10,000.

Of the 130,829 claims:
• 12 cost more than $200,000
• 176 cost more than $100,000
• 2,551 cost more than $50,000
• 7,619 cost more than $30,000
• 26,175 cost more than $20,000
• 80,674 cost between $10,000 and $20,000

Dr Armitage said PHI Funds would inject an additional $950 million into Australia’s health care system in 2009 bringing total expenditure on private health treatments to more than $11 billion.

* The 5th Annual AHIA High Claims Survey is attached.

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