A total of 12,486,627 persons held some form of private health insurance.

The proportion of the Australian population with hospital cover was 46.9%, with 54.6% of the Australian population having general treatment cover, and overall private health insurance coverage of the Australian population being 54.6%.

Selected statistics from the data presented in this publication on private health insurance membership are presented below.

For the quarter ending 31 December 2012:

• The number of insured persons increased from the previous quarter from 12,426,508 to 12,486,627 (+0.5%) for all cover, increased from 10,670,956 to 10,710,319 (+0.4%) for hospital cover and increased from 12,414,382 to 12,474,342 (+0.5%) for general treatment cover during the same period.

• The proportion of the Australian population with private health insurance increased to 54.6% for the quarter ending 31 December 2012. The proportion of the population with hospital cover decreased by 0.0% to 46.9%, and the proportion of the population with general treatment cover increased to 54.6% during the same period.

• The number of insured persons aged over 65 was 1.65 million representing 15.4% of the insured population, and 50.1% of the Australian population aged over 65. This was an increase from the previous quarter of 26,560 insured persons.

• As at December 2012, 1,086,466 insured persons were paying a Lifetime Health Cover loading, an increase from September 2012 of 0.8%.

• The average age of insured persons with hospital cover was 40.4. For insured persons with general treatment cover, the average age was 38.6.

• The age cohort with the greatest annual increase in insured persons was those aged 85-89, with an increase of 9.1%. The age cohort with the lowest annual increase was those aged 45-49, with an increase of 0.2%.

• Membership across all age cohorts increased in the year ending December 2012 when compared to the year ending December 2011.

This comprised of $11.04 billion for hospital treatment, and $3.67 billion for general treatment.

Benefits paid increased across all category types, with hospital treatment benefits increasing by 8.3% and total benefits increasing by 8.7%.

Selected statistics from the Private Health Insurance Industry Statistics publication on private health insurance benefits are presented below.

For the year ending 31 December 2012:

Hospital Treatment Benefits

• Benefits paid for treatment in All private hospitals (including freestanding day surgeries) totaled $6.894 billion, an increase of 7.9% on the year ending December 2011.

• Benefits paid for treatment in public hospitals totaled $864 million, an increase of 17.6% on the previous year.

• Benefits paid for treatment in freestanding day surgeries totaled $354.2 million, an increase of 7.9% on the previous year.

• Private health insurance funds paid benefits of $1.7658 billion for medical services, an increase of 8.8% from the previous year.

• $1.520 billion was paid to insured persons for prostheses items, an increase of 4.9% from the year ending 31 December 2011.

General Treatment Benefits

• A total of $3.67 billion was paid for allied health services in the year ending 31 December 2012, an increase of 9.5% from the previous year.

• Of the $3.67 billion in allied health services benefits, $1.87 billion was paid for dental services (+8.9%), $652 million for optical services (+8.8%), $257 million for chiropractic services (+9.5%), $305 million for physiotherapy services (+13.0%) and $120 million for natural therapies services (+25.1%) when compared to the year ending December 2011.

• Benefits paid for treatment provided in a hospital-substitute setting totaled $26.6 million during the period.

• Private health insurance funds paid $57.58 million in benefits for chronic disease management programs during the period.

Episodes of Care

Of these, 3.02 million episodes (+4.3%) and 7.43 million bed days (+4.3%) were used in private hospitals (including freestanding day surgeries). Public hospitals accounted for 597,510 episodes (+14.3%) and 2.47 million bed days (+11.5%), and freestanding day surgeries accounted for the remaining 536,040 episodes (+4.1%) and 536,046 bed days (+4.1%).

Selected statistics from the data presented in this 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 31 December 2011.

For the year ending 31 December 2012:

• Of the acute private hospital episodes for the period, 1.471 million were same day procedures (+5.9%) and 1,008,883 were overnight procedures (+2.2%).

• Of the acute public hospital episodes for the period, 257,995 were same day procedures (+13.4%) and 339,515 were overnight procedures (+14.9%).

• 62.7% of all privately insured episodes were same day procedures.

• Nursing home type patients accounted for 3,779 episodes during this period. These episodes accounted for 79,872 bed days.

• Private health insurers paid benefits for 30.63 million medical services during the year ending 31 December 2012.

• Of these medical services, benefits were paid on 1.143 million services under a policy with some form of gap agreement. Benefits for 23.83 million medical services were paid under a policy with a no gap
agreement.

• 88.5% of medical services had benefits paid with no medical gap during the period.

• Benefits were paid for 1.99 million prostheses items during the period, an increase of 7.0%.

• 186,882 Broader Health Cover services were funded during the year ending 31 December 2012. Of these, 99,735 were for procedures performed in a hospital-substitute setting, and 87,147 were for
chronic disease management programs.

• Benefits were paid for 74.891 million allied health services, an increase of 5.4%. Of these, 31.377 million were dental services (+4.7%), 9.916 million were optical services (+5.1%), 9.511 million were for
chiropractic services (+3.8%), 9.739 million were for physiotherapy services (+6.7%) and 4.461 million were for natural therapies services (+19.3%).

Utilisation

Hospital accommodation benefits paid by private health insurers for episodes in freestanding day surgeries in the year ending December 2012 equaled $661 per bed day and $661 per episode. Hospital accommodation benefits paid for public hospitals during the same time period equaled $349 per bed day, and $1,447 per episode. For private hospitals, hospital accommodation benefits paid equaled $942 per bed day, or $2,620 per episode. Overall, the average total hospital treatment benefits paid per bed day for a privately insured patient was $1,115, or $3,056 per episode.

For the year ending 31 December 2012:

• Of each hospital episode, an average of $2,135 per episode was accounted for by accommodation costs, $489 was accounted for by medical service costs, and $421 per episode was accounted for by
prostheses items.

• The total private health insurance benefits paid per insured person was $1,203. For hospital benefits paid per insured person, the figure was $1,045.

• The average length of stay for a public hospital episode was 4.14 days, and for a private hospital episode, 2.78 days. Overall, the average length of stay for an episode in any hospital was 2.74 days.

• The average length of stay for an overnight public hospital episode was 6.53 days. For an overnight private hospital episode, the average length of stay was 5.38 days.

• There were 51 free-standing day surgery bed days utilised during the year ending December 2012 per 1,000 insured persons, with 234 public bed days and 653 private bed days for the same period. Overall, 938 hospital bed days were used per 1,000 insured persons during the period.

• The average benefits paid for an allied health service was $49, with the average cost per service at $96. The benefits paid by private health insurers for allied health services represented 51.0% of the costs of these services.

• The average benefit paid per dental service was $60, with $66 being paid per optical service, $31 per physiotherapy service, $27 per natural therapies service, and $27 per chiropractic service.

Private health insurance also offers cover for some or all of the costs of other services not covered by Medicare, such as ambulance services, dental, optical items, physiotherapy and a wide range of other services.

Unlike other insurances, your premium is not affected by your age, health status or other risk factors. This is called community rating and it protects from having to pay higher premiums if you make a claim, or as you get older, or if you get sick.

Private Healthcare Australia Member Funds Contact Details

Private health insurance is provided through organisations registered under the Private Health Insurance Act 2007. The financial performance of registered health funds is monitored by the Private Health Insurance Administration Council (PHIAC), an independent Australian Government body, to ensure solvency and capital adequacy requirements are met. All members of Private Healthcare Australia are registered as health benefits organisations with the Commonwealth Government and therefore comply with Government standards and regulations on benefits and solvency.

The Australian Government regulates private health funds but rules regarding membership vary between funds and in some cases will vary between States. For example, all health funds have certain waiting periods and other conditions that apply before benefits are payable.

If you wish to join a health fund, or wish detailed information about what our members offer, try the links below:

(*Click here to get our member funds’ contact details when telephoning from overseas, i.e. outside Australia)

As at 30 September 2012, the number of insured persons with hospital cover was 10,670,956 and the number of insured persons with general treatment cover was 12,414,382.

A total of 12,426,508 persons held some form of private health insurance.

The proportion of the Australian population with hospital cover was 46.9%, with 54.5% of the Australian population having general treatment cover, and overall private health insurance coverage of the
Australian population being 54.6%.

Selected statistics from the Private Health Insurance Industry Statistics for September 2012 are presented below.

For the quarter ending 30 September 2012:

• The number of insured persons increased from the previous quarter from 12,321,848 to 12,426,508 (+0.8%) for all cover, increased from 10,587,828 to 10,670,956 (+0.8%) for hospital cover and increased from 12,310,102 to 12,414,382 (+0.8%) for general treatment cover during the same period.

• The proportion of the Australian population with private health insurance increased to 54.6% for the quarter ending 30 September 2012. The proportion of the population with hospital cover increased by 0.2% to 46.9%, and the proportion of the population with general treatment cover increased to 54.5% during the same period.

• The number of insured persons aged over 65 was 1.62 million representing 15.2% of the insured population, and 50.8% of the Australian population aged over 65. This was an increase from the previous quarter of 24,353 insured persons.

• As at September 2012, 1,077,372 insured persons were paying a Lifetime Health Cover loading, an increase from June 2012 of 2.3%.

• The average age of insured persons with hospital cover was 40.3. For insured persons with general treatment cover, the average age was 38.5.

• The age cohort with the greatest annual increase in insured persons was those aged 65-69, with an increase of 9.2%. The age cohort with the lowest annual increase was those aged 45-49, with an increase of 0.2%.

• Membership across all age cohorts increased in the year ending September 2012 when compared to the year ending September 2011.

The total benefits paid by private health insurance funds for all types of hospital and general treatment services in the year ending September 2012 was $14.466 billion (Source: PHIAC Quarterly Statistics, September 2012).

This comprised of $10.81 billion for hospital treatment, and $3.57 billion for general treatment.

Benefits paid increased across all category types, with hospital treatment benefits increasing by 7.9% and total benefits increasing by 8.2%.

Selected statistics from the Private Health Insurance Industry Statistics publication on private health insurance benefits are presented below.

For the year ending 30 September 2012:

Hospital Treatment Benefits

• Benefits paid for treatment in All private hospitals (including freestanding day surgeries) totaled $6.764 billion, an increase of 7.8% on the year ending September 2011.

• Benefits paid for treatment in public hospitals totaled $820 million, an increase of 13.9% on the previous year.

• Benefits paid for treatment in freestanding day surgeries totaled $347.1 million, an increase of 8.9% on the previous year.

• Private health insurance funds paid benefits of $1.7356 billion for medical services, an increase of 8.5% from the previous year.

• $1.494 billion was paid to insured persons for prostheses items, an increase of 5.0% from the year ending 30 September 2011.

General Treatment Benefits

• A total of $3.57 billion was paid for allied health services in the year ending 30 September 2012, an increase of 8.8% from the previous year.

• Of the $3.57 billion in allied health services benefits, $1.82 billion was paid for dental services (+7.9%), $634 million for optical services (+8.9%), $252 million for chiropractic services (+9.2%), $296 million for physiotherapy services (+11.7%) when compared to the year ending September 2011.

• Benefits paid for treatment provided in a hospital-substitute setting totaled $24.9 million during the period.

• Private health insurance funds paid $52.90 million in benefits for chronic disease management programs during the period.

Private health insurers paid benefits for 3.56 million hospital episodes in the year ending September 2012, with associated bed days numbering 9.73 million (Source: PHIAC Quarterly Statistics, September 2012).

Episodes of Care

Of these, 2.99 million episodes (+4.8%) and 7.36 million bed days (+4.1%) were used in private hospitals (including freestanding day surgeries). Public hospitals accounted for 571,299 episodes (+10.2%) and 2.37 million bed days (+7.3%), and freestanding day surgeries accounted for the remaining 529,677 episodes (+5.0%) and 529,730 bed days (+5.0%).

Selected statistics from the data presented in this 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 2011.

For the year ending 30 September 2012:

• Of the acute private hospital episodes for the period, 1.457 million were same day procedures (+6.7%) and 1,003,360 were overnight procedures (+2.0%).

• Of the acute public hospital episodes for the period, 246,350 were same day procedures (+9.1%) and 324,949 were overnight procedures (+11.0%).

• 62.7% of all privately insured episodes were same day procedures.

• Nursing home type patients accounted for 3,816 episodes during this period. These episodes accounted for 81,299 bed days.

• Private health insurers paid benefits for 30.01 million medical services during the year ending 30 September 2012.

• Of these medical services, benefits were paid on 1.158 million services under a policy with some form of gap agreement. Benefits for 23.29 million medical services were paid under a policy with a no gap
agreement.

• 88.4% of medical services had benefits paid with no medical gap during the period.

• Benefits were paid for 1.95 million prostheses items during the period, an increase of 7.4%.

• 172,840 Broader Health Cover services were funded during the year ending 30 September 2012. Of these, 92,777 were for procedures performed in a hospital-substitute setting, and 80,063 were for
chronic disease management programs.

• Benefits were paid for 73.589 million allied health services, an increase of 4.5%. Of these, 30.857 million were dental services (+3.8%), 9.725 million were optical services (+5.3%), 9.415 million were for
chiropractic services (+3.1%) and 9.575 million were for physiotherapy services (+5.4%).

Utilisation

Hospital accommodation benefits paid by private health insurers for episodes in freestanding day surgeries in the year ending September 2012 equaled $655 per bed day and $655 per episode. Hospital accommodation benefits paid for public hospitals during the same time period equaled $346 per bed day, and $1,436 per episode. For private hospitals, hospital accommodation benefits paid equaled $934 per bed day, or $2,591 per episode. Overall, the average total hospital treatment benefits paid per bed day for a privately insured patient was $1,112, or $3,036 per episode.

For the year ending 30 September 2012:

• Of each hospital episode, an average of $2,118 per episode was accounted for by accommodation costs, $487 was accounted for by medical service costs, and $420 per episode was accounted for by
prostheses items.

• The total private health insurance benefits paid per insured person was $1,185. For hospital benefits paid per insured person, the figure was $1,030.

• The average length of stay for a public hospital episode was 4.15 days, and for a private hospital episode, 2.77 days. Overall, the average length of stay for an episode in any hospital was 2.73 days.

• The average length of stay for an overnight public hospital episode was 6.54 days. For an overnight private hospital episode, the average length of stay was 5.35 days.

• There were 50 free-standing day surgery bed days utilised during the year ending September 2012 per 1,000 insured persons, with 226 public bed days and 651 private bed days for the same period. Overall, 927 hospital bed days were used per 1,000 insured persons during the period.

• The average benefits paid for an allied health service was $49, with the average cost per service at $96. The benefits paid by private health insurers for allied health services represented 50.7% of the costs of these services.

• The average benefit paid per dental service was $59, with $65 being paid per optical service, $31 per physiotherapy service and $27 per chiropractic service.

The 2012 Private Healthcare Australia National Conference – Private Healthcare: Better Value, was held on the 14-15 November 2012, Park Hyatt in Melbourne.

The year 2012 was a particularly significant one for the Private Health Insurance Industry. We have had legislative issues with which to deal; the community had been severely impacted by economic realities, affecting their discretionary expenditure; demand for health services continues to climb; and Australia’s population continues to age.

The Annual Conference of Private Healthcare Australia was an ideal opportunity for delegates to gain insight into how to best tackle these problems, and to consider, share and debate with their peers possible solutions.

The Conference was the perfect event for industry leaders and managers, policy and product developers, government officials, health agencies, and those involved with health data and finance.

Both the Minister and the Shadow Minister for Health were invited to address the Conference, and with the political circumstances being as unpredictable as they are, it was a fascinating opportunity to hear first-hand their proposed directions for our Industry into the future.

The Conference was also addressed by International Speakers of the highest calibre, in areas of critical importance to the Industry such as Fraud prevention; Quality care; Business issues; Cost control; and the nuances of the World Economy. Speakers included:

• Sir Andrew Dillon, National Institute for Health and Clinical Experience, UK
• Evan Falchuk, Best Doctors, USA, named a ‘Solutions Superstar’ by CDHC Health Solutions
• Scott Haslem, Managing Director and Chief Economist, UBS, Australia
• Niki Savva, political correspondent, press secretary and adviser
• Professor Malcolm Sparrow, Harvard University, USA and author of License to Steal: how Fraud Bleeds America’s Health Care System

A total of 12,321,848 persons held some form of private health insurance.

The proportion of the Australian population with hospital cover was 46.8%, with 54.4% of the Australian population having general treatment cover, and overall private health insurance coverage of the Australian population being 54.5%.

Selected statistics from the Private Health Insurance Industry Statistics for June 2012 are presented below.

For the quarter ending 30 June 2012:

• The number of insured persons increased from the previous quarter from 12,173,766 to 12,321,848 (+1.2%) for all cover, increased from 10,455,462 to 10,587,828 (+1.3%) for hospital cover and increased from 12,162,753 to 12,310,102 (+1.2%) for general treatment cover during the same period.

• The proportion of the Australian population with private health insurance increased to 54.5% for the quarter ending 30 June 2012. The proportion of the population with hospital cover increased by 0.4% to 46.8%, and the proportion of the population with general treatment cover increased to 54.4% during the same period.

• The number of insured persons aged over 65 was 1.60 million representing 15.1% of the insured population, and 50.4% of the Australian population aged over 65. This was an increase from the previous quarter of 18,658 insured persons.

• As at June 2012, 1,052,994 insured persons were paying a Lifetime Health Cover loading, an increase from March 2012 of 4.6%.

• The average age of insured persons with hospital cover was 40.3. For insured persons with general treatment cover, the average age was 38.5.

• The age cohort with the greatest annual increase in insured persons was those aged 65-69, with an increase of 9.9%. The age cohort with the lowest annual increase was those aged 60-64, with an increase of 0.1%.

• Membership across all age cohorts increased in the year ending June 2012 when compared to the year ending June 2011.

This comprised of $10.62 billion for hospital treatment, and $3.51 billion for general treatment.

Benefits paid increased across all category types, with hospital treatment benefits increasing by 9.3% and total benefits increasing by 9.3%.

Selected statistics from the Private Health Insurance Industry Statistics publication on private health insurance benefits are presented below.

For the year ending 30 June 2012:

Hospital Treatment Benefits

• Benefits paid for treatment in All private hospitals (including freestanding day surgeries) totaled $6.647 billion, an increase of 8.9% on the year ending June 2011.

• Benefits paid for treatment in public hospitals totaled $787 million, an increase of 15.5% on the previous year.

• Benefits paid for treatment in freestanding day surgeries totaled $339.2 million, an increase of 10.7% on the previous year.

• Private health insurance funds paid benefits of $1.7021 billion for medical services, an increase of 9.9% from the previous year.

• $1.483 billion was paid to insured persons for prostheses items, an increase of 7.5% from the year ending 30 June 2011.

General Treatment Benefits

• A total of $3.51 billion was paid for allied health services in the year ending 30 June 2012, an increase of 8.9% from the previous year.

• Of the $3.51 billion in allied health services benefits, $1.79 billion was paid for dental services (+8.4%), $624 million for optical services (+8.8%), $247 million for chiropractic services (+9.8%), $288 million for physiotherapy
• services (+11.6%) and $108 million for natural therapies services (+24.0%) when compared to the year ending June 2011.

• Benefits paid for treatment provided in a hospital-substitute setting totaled $24.6 million during the period.

• Private health insurance funds paid $49.28 million in benefits for chronic disease management programs during the period.