Hike in treatments, benefits paid for private health patients

Peter Terlato 17 August 2016

Female doctor nurse hospital health patient

But out-of-pocket expenses increase in the June quarter.

There has been a sharp rise in the number of hospital treatment episodes and benefits paid for private health insurance customers in the second quarter of 2016.

The Australian Prudential Regulatory Authority (APRA) released quarterly statistics for June 2016, revealing hospital utilisation for privately insured Aussies increased 13.2% quarter-on-quarter in June, totalling 1,161,798 episodes.

An episode is defined as the services provided by a hospital in the continuous course of care of a patient with a health condition. It may cover a sequence from emergency through inpatient to outpatient services.

Episodes in all hospital settings increased over the June quarter: Public hospitals (8.6%), private hospitals (13.8%), day hospital facilities (13.8%) and hospital-substitutes (24.9%).

Total benefits paid for hospital treatment benefits rose 14% during the June quarter, while benefits paid for general treatments (ancillary) decreased 2.7% compared with March.

The average out-of-pocket (gap) payment for a hospital episode was $301 in the June quarter 2016, up 6.9% compared to the same period last year.

Average out-of-pocket payments for medical services were $136. The medical specialty with the greatest out-of-pocket payment was plastic/reconstructive surgery with an average gap of $349, followed by orthopaedic with an average gap payment of $344.

Despite a reduction in the number of gap-free services, average gap payments increased slightly last quarter.

While the average gap payment may seem low at just $19.23, it conceals some much larger individual numbers.

Those aged between 60 and 79 received the most benefits paid for hospital treatment. There was a rise in benefits paid to those in the 20–39 age bracket but this was tied to an increase in female benefits associated with child bearing.

General treatment (ancillary) benefits for covered individuals during the year to June 2016 were $387, up from $376 for the year to June 2015. The most significant benefits were dental services, at $203 per person.

Just under half (47%) of the population had hospital treatment cover as at 30 June 2016, while a little over half (55.7%) had some form of general treatment cover.

However, a quarter of Aussies suffering chronic illness avoid or aren't able to access suitable healthcare as a result of high-priced services.

Picture: Shutterstock

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