Australia’s largest private health insurer, Medibank Private, paid more than $300,000 for a single member claim last year, demonstrating the value of having private health insurance.
In releasing its Annual Top Ten member claims payouts for 2003 the collective top-ten member benefit figures for the health insurer were all greater than $130,000.
See attachment – Top Ten Medibank Private Benefit and Procedure Payouts for 2003.
Orthopaedic surgery was the most expensive speciality, costing the fund $208.36 million over the twelve-month period, followed by cardio-thoracic (heart) surgery ($164.78 million) and gastro/intestinal procedures ($91.97 million).
See attachment – Top Five Reasons for Admission to Hospital for 2003.
Other high paying reasons for admission to hospital included psychiatry ($42 million) and gynaecological procedures ($46 million).
Medibank Private Managing Director George Savvides said that the biggest individual member benefit payment ($307,736) identified the underlying value of having private health cover.
“Many of our members don’t realise how expensive health care services in hospital can be,” Mr Savvides said.
“Often, it’s not until a member has had a hospital episode that they start to understand the real cost of receiving quality and timely health care.
“Within Medibank Private we have streamlined our business to bring our management expense cost to below 9 per cent of total member contributions.
“This means we have more funds on hand to pay claims on behalf of our members,” he said.
Mr Savvides said such high six-figure payout amounts show that self-insurance is not a viable alternative to private health insurance cover for individuals or families.
“The concept of self-insuring for private hospital care assumes that you will only need hospital or medical treatment once you’ve saved up appropriate funds,” Mr Savvides said.
“However, I would suggest that it would take the average person a long period to accumulate the dollar amount that we regularly pay out on behalf of members.
“Private health insurance gives you access to quality health cover when you need it, not when you’ve saved up enough funds.”
In the 2003 financial year, Medibank Private for the first time paid out more than $2 billion ($2,053.6 million) in member benefits. This figure equates to 92.3% of total member contributions.
TOP TEN MEDIBANK PRIVATE BENEFIT PAYOUTS FOR 2003
1. $307,736
2. $216,924
3. $181,058
4. $153,103
5. $150,977
6. $141,304
7. $137,972
8. $132,935
9. $132,770
10. $130,711
TOP FIVE REASONS FOR ADMISSION TO HOSPITAL FOR 2003
1. Reason for admission: Orthopaedic
$ Amou $208,367,474
No. of episodes 47,312
2. Reason for admission: Cardio-thoracic
$ Amou $164,786,542
No. of episodes 28,205
3. Reason for admission: Gastro/Intestinal
$ Amou $91,970,602
No. of episodes 80,140
4. Reason for admission: Obstetrics
$ Amou $73,521,504
No. of episodes 25,934
5. Reason for admission: Gynaecological
$ Amou $46,151,335
No. of episodes 30,351