Media releases

January 31, 2005

Top 10 Medibank Private claims exceed $1.8 million

The value of leading private health insurer Medibank Private's Top 10 member claims ballooned by almost 9 per cent in the last financial year, according to a review of the company's annual Chart Toppers Index.

The Index is a ranking of Medibank Private's Top 10 insurance claims for the 12 months ending June 2004 and is produced by an actuarial analysis of Medibank Private member claims and their corresponding benefit payouts.

For its top 10 claiming members, Medibank Private paid out a record $1.839 million in benefits in the 2003/2004 financial year - about $162,000 more than the combined value of the Top 10 in 2003.

Of the Top 10:

  • The highest payout of $267,625 went to a 67-year-old female member for cardiothoracic treatment;
  • Three claims totalling $564,158 were for ear, nose and throat treatments;
  • Three claims totalling $549,025 were for cardiothoracic treatments; and
  • One claim totalling $163,625 was for neo-natal treatment of a newborn.

The Chart Toppers Index also offers an analysis of the most common reasons for Medibank Private member hospital admissions and their associated benefit claims.

This showed Medibank Private in 2004 funded claims of:

  • $253 million for 51,871 member orthopaedic procedures, with an average payout of $4,868 per claiming member, and a highest payout of $84,741;
  • $206 million for 31,539 member circulatory system procedures, with an average payout of $6,522 per claiming member;
  • $116 million for 87,052 member digestive system procedures, with an average payout of $1,333 per claiming member;
  • $84 million for 26,409 member obstetrics treatments, with an average payout of $3,185 per claiming member; and
  • $53 million for 30,778 member gynaecological procedures, with an average payout of $1,729 per claiming member.

Medibank Private Managing Director George Savvides said the composition of Medibank Private benefit payouts in 2004 demonstrated that members are increasing their use of their health insurance to pay for, in many cases, complicated and life threatening treatments.

He said the 9 per cent increase in the combined value of the fund's Top 10 claims demonstrated the real-world impact of rising medical costs forced by a combination of the uptake of new medical technology and the aging population.

"Most of the community may not realise how expensive health care services from hospitals can be," Mr Savvides said.

"With nearly 3 million members, Medibank Private's combined hospitals and ancillaries benefits in the 2003-04 financial year exceeded $2.4 billion, an increase of $156 million on the previous year, and a further reflection of the impact of higher medical costs."

Mr Savvides said the composition of the medical interventions most frequently covered by the fund dispelled an isolated view in the community that private health insurance was only valuable for covering at-times optional ancillary services.

"The Index shows that the majority of member claims are for treating serious ailments, from orthopaedic presentations (51,871 episodes) right through to circulatory and digestive conditions," he said.

"Australian Institute of Health and Welfare statistics show private hospitals perform 45% of all cardiac value procedures and 44% of all coronary bypass operations. This is further proof that private health insurance is a critical part of the provision of high-end, acute medical care."


2004 Medibank Private Chart Toppers IndexTop 10 Benefit Payouts

Treatment

Gender

Age

Total Benefit Paid


Cardiothoracic

Female

67

$267,625

Ear, nose & throat

Male

59

$250,382

Urological

Male

61

$233,373

Reconstructive plastic surgery

Female

64

$185,450

Ear, nose & throat

Male

61

$163,797

Neo natal

Female

Infant

$163,625

Ear, nose & throat

Male

62

$149,979

Neurosurgical

Female

70

$148,897

Cardiothoracic

Male

78

$147,546

Cardiothoracic

Female

74

$133,854

Top 5 Reasons for Hospital Admissions


Reason for Admission

Number of Separations

Total Benefits

Orthopaedic

51,871

$252,530,029

Circulatory

31,539

$205,700,267

Digestive

87,052

$116,111,043

Obstetrics

26,409

$84,122,589

Gynaecology

30,778

$53,219,521


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