Southern Cross Health Society has released a list of its most expensive health insurance claims over a period of 12 months, and has paid out over $200 million for the top five procedures on the list combined.
Knee and hip replacements took top spot, with $94.7 million paid out across almost 4,000 combined claims. Colonoscopies took third place with over 20,000 claims totalling almost $44 million, followed by excision skin lesions and cataract surgery.
Although only 8% of all claims were for elective surgery, they accounted for over 70% of overall claims costs, with the most expensive surgery – a spinal fusion – coming in at $211,978. According to Chief Medical Officer Dr Stephen Child, the statistics have provided Southern Cross Health Society with a valuable level of insight into the health requirements of New Zealanders.
“The most important takeaway is just how much elective surgery is done privately,” Child told Insurance Business.
“About 50% of all elective surgery in New Zealand is done in private practice, and Southern Cross accounts for around 18% of those procedures. This means we pay for a significant proportion of the elective surgery done at a national level, and so we are a major contributor to the healthcare system in New Zealand.”
Child says that the statistics gathered will be used to steer Southern Cross’s focus over the coming years, and to ensure that members are getting the best possible value for their premiums. Southern Cross Health Society paid out 92c in claims for every dollar it received in the 2018 financial year – a greater than average return when compared to other insurers.
“We’re a not-for-profit organisation, so what we’re trying to do is to be good stewards for our member’s money and purchase them the best healthcare that they can get,” Child said. “These figures point out that these are the things our members need, and so it points towards where we should be directing our energies and focus to ensure that we keep up that value.”
“The public healthcare system in New Zealand is great for acute problems, but it is under increased pressure,” he continued. “ACC is very supportive, and the cancer care is also superb. But the primary reason people get private health insurance is for access, choice and speed.”
“You never know what’s around the corner, and the safety net that health insurance provides can be a huge relief to ensure you receive high quality treatment when you need it.”
