Episodes and Services

Private health insurers paid benefits for 3.29 million hospital episodes in the year ending March 2011, with associated bed days numbering 8.9 million. Of these, 2.8 million episodes (+3.4%) and 6.8 million bed days (+4.5%) were used in private hospitals. Public hospitals accounted for 490,137 episodes (+8.2%) and 2.0 million bed days (+5.1%), and freestanding day surgeries accounted for the remaining 485,630 episodes (+6.1%) and bed days (+6.1%).

Selected statistics from the AHIA Private Health Insurance Industry Statistics Quarterly Report for period ending 31 March 2011 are presented below:

Hospital Episodes

• Of the acute private hospital episodes for the period, 1.36 million were same day procedures (+3.2%) and 957,863 were overnight procedures (+2.3%).

• Of the acute public hospital episodes for the period, 219,727 were same day procedures (8.7%) and 270,410 were overnight procedures (+7.8%).

• 62.6% of all privately insured episodes were same day procedures.

• Hospital Benefits per episode per benefit type shows that 70% of cost is for hospital accomodation

• Nursing home type patients accounted for 3,801 episodes during the quarter. These episodes accounted for 88,989 of all bed days.

Medical Services

• Private health insurers paid benefits for 27.2 million medical services during the year ending 31 March 2011.
• Of these medical services, benefits were paid on 1.2 million services under a policy with some form of gap agreement. Benefits for 19.7 million medical services were paid under a policy with a no gap agreement.
• 72.4% of medical services had benefits paid without a gap during the period.

Prostheses Services

• Benefits were paid for 1.7 million prostheses services during the period, an increase of 8.9%.

Broader Health Cover

• 116,306 Broader Health Cover services were funded during the year ending 31 March 2011. Of these, 53,746 were for procedures performed in a hospital-substitute setting, and 62,560 were for chronic disease management programs.

Allied Health Services

• Benefits were paid for 68.6 million allied health services, an increase of 5.1%.

• Of these, 29.1 million were dental services (+3.5%), 8.9 million were optical services (+13.1%), 8.9 million were for chiropractic services (+13.3%), 8.9 million were for physiotherapy services (+13.2%), and 2.3 million were for podiatry services (+3.3%).

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