Medibank: 10 biggest hospital benefits claims
Substantial increases in admissions and benefits paid.
Neonatal health care dominated the top ten highest paid national hospital benefits claims, according to private health insurer Medibank's latest expenditure report.
Medibank's Health Cost and Utilisation Report 2016 reveals 6 of the top 10 largest payouts were for neonatal care, with the highest single claim exceeding $430,000 for a NSW beneficiary.
Neonatal care refers to newborn infants or the first 28 days of a child's life.
The four other procedures that warranted significant claims were all tracheostomies, of which the highest amount paid ($339,273) was claimed by a 62-year-old Queensland member.
A tracheostomy is where a surgical incision is made to the windpipe to relieve breathing obstructions.
Top 10 Medibank hospital claims 2016
| Procedure | Patient age | Membership state | Benefits paid for single claim |
|---|---|---|---|
| Neonatal | 0 | NSW | $430,599 |
| Neonatal | 0 | QLD | $366,591 |
| Neonatal | 0 | QLD | $364,864 |
| Neonatal | 0 | QLD | $345,273 |
| Tracheostomy | 62 | QLD | $339,273 |
| Tracheostomy | 79 | NSW | $318,608 |
| Neonatal | 0 | QLD | $293,659 |
| Neonatal | 0 | QLD | $284,377 |
| Tracheostomy | 80 | QLD | $274,423 |
| Tracheostomy | 80 | SA | $270,219 |
The report also identified sizable increases in admissions and benefits paid to Medibank customers, particularly in the areas of childbirth, rehabilitation and joint surgeries.
Despite admissions falling 16% over the last four years, childbirths (19,472 in 2016) remain the most common overnight procedures in terms of hospital claims.
Rehab and knee replacement admissions increased 15% and 11% respectively between 2013 and 2016.
Five most common overnight procedures
| Procedure | No. hospital admissions (2016) | Admissions (2013-2016) | Average total cost (2016) |
|---|---|---|---|
| Childbirth | 19,472 | -14% | $9,421 |
| Rehab | 17,175 | 15% | $11,015 |
| Knee replacement | 8,161 | 11% | $24,127 |
| Shoulder procedures | 6,281 | -5% | $10,176 |
| Hip replacement | 5,695 | 4% | $27,702 |
The five most common same-day services were colonoscopies, chemotherapy, dialysis, rehab and cataract procedures. Since 2013, chemo admissions have risen 8% and cataract procedures are up 7%.
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