Episodes of Service and Utilisation of Private Health Insurance – Sept 2011
21 December 2011
Private health insurers paid benefits for 3.37 million hospital episodes in the year ending September 2011, with associated bed days numbering 9.27 million (PHIAC Quarterly Statistics Sept 2011)
Episodes of Care
Of these, 2.85 million episodes (+3.7%) and 7.06 million bed days (+7.6%) were used in private hospitals (including freestanding day surgeries). Public hospitals accounted for 518,577 episodes (+11.0%) and 2.21 million bed days (+12.1%), and freestanding day surgeries accounted for the remaining 504,313 episodes (+8.1%) and 504,313 bed days (+8.1%).
Selected statistics from the PHA Private Health Insurance Industry Statistic publication on private health insurance episodes and services are presented below. All percentage change comparisons given in brackets represent the change from the year ending 30 September 2010.
For the year ending 30 September 2011:
- Of the acute private hospital episodes for the period, 1.365 million were same day procedures (+1.5%) and 982,474 were overnight procedures (+4.7%).
- Of the acute public hospital episodes for the period, 225,864 were same day procedures (+6.5%) and 289,361 were overnight procedures (+14.5%).
- 62.2% of all privately insured episodes were same day procedures.
- Nursing home type patients accounted for 4,200 episodes during this period. These episodes accounted for 97,074 bed days.
- Private health insurers paid benefits for 28.35 million medical services during the year ending 30 September 2011.
- Of these medical services, benefits were paid on 1.086 million services under a policy with some form of gap agreement. Benefits for 21.35 million medical services were paid under a policy with a no gap agreement.
- 75.3% of medical services had benefits paid without a gap during the period.
- Benefits were paid for 1.82 million prostheses items during the period, an increase of 11.0%.
- 149,518 Broader Health Cover services were funded during the year ending 30 September 2011. Of these, 86,932 were for procedures performed in a hospital-substitute setting, and 62,586 were for chronic disease management programs.
Benefits were paid for 70.388 million allied health services, an increase of 5.7%. Of these, 29.738 million were dental services (+4.2%), 9.237 million were optical services (+12.3%), 9.134 million were for chiropractic services (+3.3%), 9.083 million were for physiotherapy services (+4.8%), and 3.597 million were for natural therapies services (+20.2%).
Utilisation
Hospital accommodation benefits paid by private health insurers for episodes in freestanding day surgeries in the year ending September 2011 equaled $632 per bed day and $632 per episode. Hospital accommodation benefits paid for public hospitals during the same time period equaled $326 per bed day, and $1,389 per episode. For private hospitals, hospital accommodation benefits paid equaled $903 per bed day, or $2,522 per episode. Overall, the average total hospital treatment benefits paid per bed day for a privately insured patient was $1,080, or $2,971 per episode.
For the year ending 30 September 2011:
- Of each hospital episode, an average of $2,065 per episode was accounted for by accommodation costs, $474 was accounted for by medical service costs, and $422 per episode was accounted for by prostheses items.
- The total private health insurance benefits paid per insured person was $1,131. For hospital benefits paid per insured person, the figure was $983.
- The average length of stay for a public hospital episode was 4.26 days, and for a private hospital episode, 2.79 days. Overall, the average length of stay for an episode in any hospital was 2.75 days.
- The average length of stay for an overnight public hospital episode was 6.78 days. For an overnight private hospital episode, the average length of stay was 5.28 days.
- There were 49 free-standing day surgery bed days utilised during the year ending September 2011 per 1,000 insured persons, with 217 public bed days and 644 private bed days for the same period. Overall, 910 hospital bed days were used per 1,000 insured persons during the period.
- The average benefit paid for an allied health service was $47, with the average cost per service at $96. The benefits paid by private health insurers for allied health services represented 49% of the costs of these services.
- The average benefit paid per dental service was $57, with $63 being paid per optical service, $29 per physiotherapy service, $25 per natural therapies service, and $25 per chiropractic service.
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