Knee and Hip Replacement top Southern Cross claims

Knee and Hip Replacement top Southern Cross claims

Venkat Raman
Auckland, July 21, 2019

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Knee and Hip Replacement topped the insurance claims settled by the South Cross Health Society last year, figures released over the weekend reveal.

Chief Medical Officer Dr Stephen Child said that the Society paid a whopping $94.7 million in settlement of claims filed by its customers during the past financial year.

The amount includes surgical procedures.

Knee and hip replacements were in every region’s list of top five claims made to Southern Cross Health Society in the last year, except Gisborne, he said.

Dr Child said that while knee replacement claims were $47.4 million, those relating to hip replacements were $47.2 million. Colonoscopies claimed the three place at $44 million, followed by Skin Lesion Removals ($37.5 million) and Cataract Extraction and Inserts ($28.2 million).

Although only 8% (240,000 procedures) of claims related to elective surgery, they accounted for 70% of overall claims costs, with the most expensive surgery placed at $211,978 for a spinal fusion, he said.

Complex and Expensive

Chief Executive Nick Astwick said that many conditions require very complex and expensive treatment.

“While we have a very good public health system in New Zealand, it is under increasing pressure. You never know what is 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. The three most expensive claims from the last year were all for spinal fusion procedures.  While less common, these procedures are often the most expensive to fund due to their complexity,” he said.

This procedure type came sixth on the most expensive claims list, requiring $25 million to be paid out to New Zealanders for just 539 spinal fusion surgeries.

The surgical procedure types with the highest paid amount overall by Southern Cross Health Society were:

Differing Claims

Dr Child said that claims differ greatly according to age and gender.

“We see a lot of claims for tooth extractions from those aged under thirty. As the age of our members increases, we see a lot more of the claims on our top five list, including hip and knee replacements, colonoscopies, skin lesion removals, and cataract extraction and insertions.”

About Southern Cross Health Society:

Established in 1961, Southern Cross Health Society is New Zealand’s first health insurer and the not-for-profit Society is the country’s largest health insurance business with more than 860,000 members.

According to Southern Cross, the figures mentioned in this report reinforce the Society as an industry leader in paying claims. In the 2018 financial year, for every dollar that Southern Cross Health Society received in premiums, 92 cents were paid in claims.

“This is greater than the average rate of return among other insurers which sits at 65 cents and in some cases, as little as 59 cents,” according to a Press Note.

The Society’s Affiliated Provider programme has helped to keep rising healthcare costs in check. Following the last financial year, the programme achieved $91 million in price-related savings over five years.

To calculate the estimated price-related savings, the impact on claims of utilisation and the addition of new benefits was identified and excluded.

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