The Australian Prudential Regulation Authority (APRA) has released its latest quarterly statistics on private health insurance (PHI) for the September 2024 quarter.
The report details membership trends, benefits paid, coverage levels, and out-of-pocket costs, providing insights into the state of Australia’s private health sector.
Hospital treatment policies insured 5.9 million people as of September 2024, equating to 45% of the population. This reflects a net increase of 105,601 insured individuals compared to the June quarter, along with a rise of 0.2 percentage points in coverage.
General treatment policies, which include services like dental, optical, and physiotherapy, covered 14.7 million people, or 54.7% of the population, marking a quarterly increase of 112,764 people.
Among age groups, the highest growth in hospital treatment membership was observed in the 25-29 demographic, which saw an additional 14,723 insured individuals. The 0-4 age group experienced the most significant net increase overall, with a gain of 30,832 when considering movements between age brackets.
Hospital treatment episodes reached 5.08 million in the year ending September 2024, a 4.3% increase from the previous year and 0.2% higher than the June quarter.
During the quarter, insurers paid $4.82 billion in hospital benefits. This total includes $2.65 billion for acute care, $719 million for medical services, and $660 million for medical devices or tissue products.
General treatment services, also referred to as ancillary services, totalled 105.15 million over the year to September 2024, reflecting a 3.5% increase from the previous year. However, there was a 1.9% decrease compared to the June quarter.
Insurers paid $1.57 billion in ancillary benefits during the quarter, with dental services accounting for $894.3 million of that total.
Out-of-pocket expenses for hospital treatment episodes averaged $432.14 in the September quarter, an 8.0% increase from the same period in 2023.
For general treatment services, the average out-of-pocket cost was $60.27, up by 2.3% year-on-year.
Orthopaedic procedures saw the highest out-of-pocket expenses, averaging $707.78 per episode.
By the end of September 2024, 87.9% of adults with hospital cover had a certified age of entry of 30 or younger, avoiding lifetime health cover loadings.
However, the number of individuals with penalty loadings rose to 1.07 million, a net increase of 81,718 over the year.
Additionally, 116,493 people had their penalties removed after maintaining continuous coverage for 10 years.
Dr Rachel David, CEO of Private Healthcare Australia, highlighted the role of private health insurance in providing faster access to healthcare services.
“Overall, this data is great news for our mixed public private health system. We know an increasing number of Australians value rapid access to private hospital treatment with a doctor of their choice if they need it, as well as subsidised dental, optical, and other health services such as physiotherapy. This takes pressure off our public hospital system, so it’s there for people who need it most,” she said.
She also noted a growing reliance on private insurance among younger Australians, particularly for mental health, maternity, and dental services.
“Data shows young people get a lot of value out of having health insurance, particularly for mental health treatment. We’ve seen a dramatic increase in the number of young people accessing mental health treatment since the pandemic began,” David said.
