Health insurers in Australia disbursed a record $9.4 billion for hospital treatments exceeding $10,000 in 2024, according to the latest analysis from the Private Health Insurance Association (PHA). The findings from the 2025 Annual Hospital High Claims Report indicate that health funds processed 453,259 high claims—a 10% increase from the previous year, marking an additional 40,771 claims.
This surge in high claims accounted for more than half, specifically 50.4%, of all hospital benefits paid by health insurers in the year. Notably, mental health claims for individuals aged 65 and older rose by 13%, totaling 6,816 claims and representing $147.7 million in benefits. Within this demographic, 35% of claims were associated with depressive disorders, followed by conditions such as delirium, substance abuse, and dementia.
Among younger Australians, particularly those under the age of 30, 22,032 hospital claims exceeded the $10,000 threshold in 2024. This figure reflects a 3.4% increase compared to 2023 and is 13% higher than pre-pandemic levels recorded in 2019. Mental health remains a critical issue, with one-in-three high claims in this age group related to mental health treatment. Females constituted 70% of these claims, with the average length of hospital stay for this cohort being 26 days.
Neonatal care significantly contributed to the high claims, with $43.3 million paid out in benefits over the year. The data reveals that over 1,000 individuals were hospitalized for serious conditions that resulted in claims exceeding $100,000 each. These conditions included coronary artery disease, severe infections, cancers, diabetes, and schizophrenia, among others. Many patients faced extended hospital stays, with the highest single benefit payment recorded at $697,267 for the treatment of severe mitral valve disease, which necessitated a heart valve replacement and involved complications.
Dr. Rachel David, CEO of the PHA, emphasized the significance of these record payouts, stating, “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.” She added that this financial support not only underscores the importance of private health insurance for Australians of all ages but also alleviates pressure on the public health system.
Hospital claims categorized as ‘high’ occur when the total insurer benefit for the hospital episode of care exceeds $10,000. The 2025 Annual Hospital High Claims Report utilizes anonymised data from PHA member funds, providing insights into the demographics of claimants, including gender, age group, and the duration of their hospital stays, as well as whether these stays occurred in public or private facilities.
As the landscape of health insurance continues to evolve, the data from 2024 serves as a crucial indicator of the growing reliance on private health coverage and its impact on healthcare accessibility across Australia.
