Health insurers paid $9.4 billion for hospital treatments costing more than $10,000 last year, with new data showing that half of all hospital benefits paid in 2024 fell into this high cost category.
The latest Annual Hospital High Claims Report for 2025 reveals that funds covered 453,259 high claims over the year, an increase of more than 40,000 from 2023. These treatments accounted for 50.4 per cent of all hospital benefits paid by insurers, marking the highest level on record.
Older Australians recorded sharp increases in mental health admissions, with members aged 65 and above making 6,816 high claims for mental health care during the year. Funds paid $147.7 million towards these cases. More than a third of the claims were for depressive disorders, followed by delirium, substance abuse disorders and dementia.
Among those under 30, high claims reached 22,032, a rise of 3.4 per cent on the previous year and 13 per cent above pre pandemic levels. Neonatal care remains one of the most costly categories for this group, with benefits totalling $43.3 million.
Mental health continues to shape the experience of younger patients. One in three high claims for members aged 18 to 30 related to mental health treatment, and 70 per cent of those patients were women. Their average hospital stay lasted 26 days.
The report also shows that more than 1,000 people required care costing more than $100,000, reflecting the scale of severe illness and long hospital stays. These cases ranged from coronary artery disease and cancers to severe infections, diabetes, schizophrenia and complications linked to spinal fusions.
The highest individual benefit was $697,267 for treatment of severe mitral valve disease that required a heart valve replacement followed by complications. The patient remained in hospital for 2.7 months, including time on ventilator support with a tracheostomy.
Other cases highlighted include an extremely premature baby who spent 133 days in hospital at a cost of $486,000, a teenager with schizophrenia whose two year admission cost $259,000, a person in their 20s who spent 222 days in hospital after a stroke costing $123,000, a woman in her 30s who received two years of care for anorexia costing $272,000, and a man whose diabetes led to a leg amputation costing $231,000.
PHA CEO Dr Rachel David said the scale of the payouts showed the value of private cover for Australians dealing with complex and lengthy hospital stays. “The record amount paid out for members’ hospital high claims highlights the real and tangible value members are receiving from their private health cover when they or their loved ones need it most,” Dr David said.
“It is also taking enormous pressure off the public health system and ensuring more Australians can get the care they need, when they need it, and why health fund membership continues to grow in this country.”
A claim is classified as high when hospital benefits exceed $10,000. The report draws on anonymised data from PHA member funds and includes details about patient age, gender, length of stay and whether they were treated in public or private hospitals.
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