Private health insurers are increasingly concerned about long and intensive hospital stays for patients suffering severe post-COVID symptoms including pneumonia, delirium and muscle wastage, as researchers warn the disease continues to place immense strain on Australia’s health system.
Almost half a million hospital stays each cost private health funds $10,000 or more in 2023, the latest analysis of claims data reveals, an increase of 8 per cent on the previous year.
The most expensive claim was $785,625 for a small bowel obstruction, followed by $753,362 paid to a public hospital caring for an elderly man awaiting admission to residential aged care for 613 days, and $605,419 for a man with a serious bacterial skin infection (cellulitis).
A woman spent three months in hospital with severe complications from spinal fusion surgery to treat lower back pain, costing her insurer $343,950. A further 13 claims related to complications from spinal fusion surgery cost more than $180,000, despite doubts about the efficacy of the procedure.
The analysis by Private Health Australia, the peak body representing health funds, also found insurers continued to pay out hundreds of thousands of dollars to patients in hospitals with serious symptoms of long COVID.
In two of the most severe cases of long COVID recorded in private hospitals, a woman in her 80s spent almost 100 days in hospital, while a man’s four-month ordeal cost his insurer $70,000.
“Health funds are particularly concerned about long COVID, not only for respiratory illnesses, but the effects on a whole range of body systems,” said Private Health Australia director of policy and research Ben Harris. “COVID and long COVID are continuing to wreak havoc in the community, continuing to hospitalise people for long periods of time, and continuing to have an effect on private health insurance premiums.”
Professor Martin Hensher, a health economist at the University of Tasmania’s Menzies Institute for Medical Research, said that while the high claims represented the most extreme cases, they were a reminder of the significant burden of COVID-19 on individuals and the health system.
“This is an illness that didn’t exist five years ago … it’s additional demand on the system,” Hensher said. “The wake-up call here is that, while [long COVID] is never going to be like heart disease or cancer in terms of scale, actually we’ve got people who are being hospitalised at very high cost.”
In a separate analysis of public hospital data, published in the Medical Journal of Australia in November, Hensher and a team of researchers found hospital admissions related to post-COVID symptoms and complications cost taxpayers an average of $11,000.
Estimating the true cost of long COVID to the health system was difficult, Hensher said, because state and federal governments do not collect data on how many people have the disease.
“We don’t really understand the true scale of the problem,” Hensher said. “People really have long COVID, so we need to know how can we make the health system work properly for these people.”
Professor Steven Faux, who co-leads the long COVID clinic at St Vincent’s Hospital Sydney.Credit: James Brickwood
Professor Steven Faux, who runs the long COVID clinic at St Vincent’s Hospital in Sydney, recently had a patient in her 90s who contracted COVID in June but could not clear it, returning to hospital several times with superinfections.
“Generally, we don’t see people who are going to survive stay in hospital longer than four weeks … but what happens is they don’t get better in the community, which is the definition of long COVID,” Faux said. “The GPs struggle to continue managing them and then send them back in for more acute treatment.”
Faux said employers and insurers covering income protection were increasingly asking the clinic for help getting employees with long COVID back to work. “We’re saying they will improve because the evidence says they will, but they need access to multidisciplinary, well-coordinated treatments,” Faux said.
Federal Health Minister Mark Butler announced $14.5 million in funding for long COVID research in June, which he said would “generate knowledge to support new diagnostic and therapeutic approaches for people with long COVID”.
Faux said the St Vincent’s clinic had received funding to investigate how to care for people with long COVID but did not expect results for several years. Meanwhile, he anticipated “a sort of a struggle”.
A 2023 analysis found long COVID costs the Australian economy at least $5.7 billion. Analysis by Hensher and others published in the Medical Journal of Australia in November, estimated the annual economic burden of long COVID at between $1.7 billion and $6.3 billion.
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