Quarterly private health insurance membership and benefits summary - December 2024
Key metrics
Hospital treatment membership
General Treatment membership
Hospital treatment episodes
General treatment services (ancillary)
Benefits
Out- of -pocket per episode/service
Membership and coverage
Hospital Treatment
At 31 December 2024, 12,400,800 people, or 45.2% of the population, were covered by hospital treatment cover. There was a slight increase compared to September 2024.
There was an increase in coverage of 59,279 insured people in the December 2024 quarter compared to Sepetember 2024. Family policies increased by 7,880 and single policies by 13,118 during the quarter.
The largest increase in coverage during the quarter was 8,544 for people aged between 40-
44. The largest net increase (taking into account movement between age groups) was for the 0-4 with an increase of 23,969 people.
Net quarterly change in insured persons
Lifetime health cover
The majority of adults with hospital cover (87.8%) have a certified age of entry of 30, with no penalty loading.
At the end of the 31 December 2024 quarter, there were 1,086,499 people with a certified age of entry of more than 30 and subject to a Lifetime Health Cover loading; a net increase in people paying a penalty over the preceding 12 months of 83,833. There was a net increase in people with a certified age of entry of 30 (with no penalty) over the year of 116,321. Over the year, 108,859 people had their loading removed after paying a loading for ten years.
Number of persons insured by age
Hospital treatment tables
General Treatment
At 31 December 2024, 15,060,791 people or 54.9% of the population had some form of general treatment cover. There was an increase of 63,730 people when compared to the September quarter. There was an increase of General Treatment policies of 31,618 for December 2024 which was mainly driven by Single Policies which increased by 16,189. For the 12 months to 31 December 2024, the number of insured persons with general treatment cover has increased by 346,248.
Net quarterly change in insured persons (ancillary)
The general treatment (ancillary) by age charts and data in this report show data for those people that have general treatment policies covering ancillary services, regardless of other treatment included in the product. This excludes those general treatment policies that do not cover ancillary treatment.
There was an increase of 48,517 people with general treatment (ancillary) coverage in the December 2024 quarter. The largest net increase in coverage, after accounting for movements across age groups, was 23,575 for people in the 0 to 4 age group.
Number of persons insured by age (ancillary)
General treatment tables (ancillary)
Benefits Paid
Hospital treatment
Benefits per episode/service
| Hospital Treatment | December 2024 | Change from September 2024 |
|---|---|---|
| Acute | $2,675 | 1.0% |
| Medical | $68 | 1.3% |
| Medical devices or human tissue products | $656 | -0.6% |
| Cardiac | $3,131 | -3.6% |
| Hip | $1,602 | -1.2% |
| Knee | $1,661 | -2.1% |
| ||
| Hospital | $4,800,407,490 | -0.5% |
| General | $1,736,731,340 | 9.3% |
During the December 2024 quarter, insurers paid $4,800.41 million in hospital treatment benefits, which was 0.75% higher compared to the September 2024 quarter. Hospital treatment benefits were comprised of:
- $3,457.55 million for hospital services such as accommodation and nursing
- $721.36 million for medical services
- $621.50 million for medical devices or human tissue product.
Hospital treatment benefits paid by age 12 months to 31 December 2024
The age group for which most hospital benefits are paid is between 75 and 79 (top chart). Total benefits by age group are affected by the average benefits paid per person (displayed in the second chart) and the number of people in each age group.
Average hospital benefits per person increased from $1,433.27 for the year ending December 2023 to $1,505.65 for the year ending December 2024. The largest amount of benefits per person was spent on hospital accommodation and medical, followed by medical services and then medical devices or human tissue benefits.
| Hospital treatment benefits per person covered and percentage of benefits paid by age cohort | Hospital treatment benefits per person |
|---|---|
 |  |
General treatment
Benefits per service
December 2024 | Change from September 2024 | |
|---|---|---|
| Dental | $68 | 0.8% |
| Chiropractic | $33 | -2.7% |
| Physiotherapy | $40 | -0.4% |
| Optical | $83 | 0.6% |
During the December 2024 quarter, insurers paid $1,720.78 million in general treatment (ancillary) benefits. This was an increase of 9.5% compared to the September2024 quarter. Ancillary benefits for the December 2024 quarter included the major categories of:
- Dental $941.22 million
- Optical $317.96 million
- Physiotherapy $111.73 million
- Chiropractic $68.68 million.
General treatment benefits paid by age 12 months to 31 December 2024 (ancillary)
There is a marked difference between the distribution of benefits over age groups between hospital benefits and ancillary benefits. The major difference is the higher claiming rate in older age groups for hospital benefits while benefits per person for ancillary benefits are more evenly spread over the age groups.
General treatment (ancillary) benefits per person during the year to December 2023 were $463.35. increasing to $482.65 for the year to December 2024. The largest component of ancillary benefits is dental, for which $266.98 was paid per insured.
| General treatment benefits per person covered and percentage of benefits paid by age cohort (ancillary) | General treatment benefits per person (ancillary) |
|---|---|
 |  |
Medical benefits
Total benefits for medical services increased by 0.3% during the December quarter 2024.
The change in medical benefits paid per service was calculated over a range of medical services and does not mean medical services overall decreased or increased in cost. The average benefits paid reflects the type of medical services utilised during the quarter as well as the volume of services. The medical service for which the greatest amount of benefits was paid was anaesthetics, comprising 25.7% of all medical benefits and totalling $185.29 million.
Medical devices or human tissue benefits
Total benefits paid for medical devices or human tissue products increased by 0.2% in December 2024 compared to September 2024. Similar to medical services, the change in benefits paid for medical devices or human tissue products was calculated over a range of medical devices or human tissue products (see chart) and does not mean medical devices or human tissue products overall changed in cost. The change in benefits paid may reflect a change in the type of medical devices or human tissue products utilised, or a change in the overall utilisation of medical devices or human tissue products. The medical devices or human tissue products group for which the greatest amount of benefits were paid was cardiac, comprising 17.5% of all medical devices or human tissue products benefits and totalling $108.76 million.
Medical benefits by Speciality group
Benefits paid for medical devices or human tissue products
Service utilisation
Episodes/Services by type
| December 2024 | Change from September 2024 | |
|---|---|---|
| Hospital Episodes | 1,292,408 | -1.8% |
| Hospital Days | 3,163,400 | -3.5% |
| Medical Services | 10,566,933 | -1.0% |
| Medical devices or human tissue Item | 947,064 | 0.8% |
| Specialist Orthopaedic | 168,268 | -6.4% |
| Ophthalmic | 105,710 | 5.5% |
| Spinal | 42,474 | -2.6% |
| General Treatment | 27,624,491 | 6.1% |
| Dental | 13,939,686 | 4.4% |
| Chiropractic | 2,061,711 | -9.8% |
| Physiotherapy | 2,777,814 | -9.4% |
| Optical | 3,828,255 | 48.6% |
During the December 2024 quarter, insurers paid benefits for 3.2 million days in hospital, arising from 1.3 million hospital episodes of care.
Hospital utilisation is distributed over four categories of hospital—public, private, day only facilities and hospital-substitute. During the December 2024 quarter, hospital episodes were distributed as follows:
- public hospitals 177,937 episodes
- private hospitals 876,353 episodes
- day hospital facilities 171,679 episodes
- hospital substitute 66,439 episodes.
For the December 2024 quarter, hospital utilisation (measured in episodes) decreases by 0.2% which was mainly driven by hospitals- substitute.
| Quarter change | Year change | |
|---|---|---|
| public hospitals | ↓ -4.6% | ↑ 4.8% |
| private hospitals | ↓ 1.9% | ↑ 5.2% |
| day hospital facilities | ↑ 1.0% | ↑ 0.0% |
| hospital-substitute | ↑ 1.3% | ↑ 2.1% |
Day-only episodes in the four categories of hospital totalled 910,054 with a -1.2% change compared to September 2024.
| Hospital treatment services per 1,000 insured persons | General treatment services (ancillary) per 1,000 insured person |
|---|---|
 |  |
Out-of-pocket payments
Average out-of-pocket per episode/service
| December 2024 | Change from September 2024 | Change from December 2023 | |
|---|---|---|---|
| Hospital treatment | $439.16 | 1.6% | 7.0% |
| Hospital-substitute treatment | $3.85 | 7.8% | 22.0% |
| General treatment ancillary | $59.52 | -1.2% | 1.5% |
| Medical gap where gap was paid | $276.44 | 3.7% | 7.9% |
The average out-of-pocket (gap) payment for a hospital episode was $439 in the December 2024 quarter. This included out-of-pocket payments for medical services, in addition to any excess or co-payment amounts relating to hospital accommodation.
The out-of-pocket payments for hospital episodes increased by 7.0% compared to the same quarter for the previous year.
Out-of-pocket payments for medical services were $276.44 where an out-of-pocket payment was payable. The amount of gap for medical services varies depending on the specialty group. The specialty group with the largest out-of-pocket payment was Orthopaedic with an average gap of $730.00 Gap incurred for the various medical services is displayed in the first chart. Medical gap also varies by state and territory and these differences are shown in the bottom chart.
Medical benefits and out-of-pocket by specialty group
Proportion of services and average out-of-pocket payments
