1 This publication contains statistical information for 2008-09 financial year and previous financial years, obtained from an annual census of all licensed private hospitals in Australia. It contains details about the facilities, activities, staffing and finances of all private hospitals, including both private acute and/or psychiatric hospitals and free-standing day hospital facilities.
2 Corresponding statistics for public hospitals are compiled by the Australian Institute of Health and Welfare (AIHW) in their annual publication, Australian Hospital Statistics.
3 The data presented in this publication are supported by a series of spreadsheets that are available on the ABS website.
4 The Private Health Establishments Collection was not conducted for the 2007-08 reference period due to ABS budgetary constraints. This represents a break in the time series for the collection. The collection was reinstated for the 2008-09 reference period, and will be conducted for the 2009-10 reference period.
5 Data presented in this publication for the 2008-09 reference period have been compared to data from the 2006-07 reference period.
6 A Glossary is provided detailing definitions of terminology used within this publication and the associated data cubes.
7 All private acute and psychiatric hospitals licensed by state and territory health authorities and all free-standing day hospital facilities approved by the Australian Government Department of Health and Aging (DoHA) for the purpose of health insurance benefits are within the scope of this collection.
8 Updated lists of private hospitals are received from state, territory and Commonwealth health authorities and every effort is made to include all hospitals in scope.
9 All private hospitals in Australia which operated for all or part of the reference period are included in the collection.
10 Private patients treated in public hospitals are not part of the Private Health Establishments Collection. However, public patients treated in licensed private establishments are included in the private hospitals statistics.
11 The data items and definitions in this collection are based on the National Health Data Dictionary published by the AIHW, with some additional data items requested by private hospital associations and health authorities. Refer to the Glossary for further definitions of the data items used in this publication.
Australian Standard Geographical Classification (ASGC)
12 The ASGC is an hierarchical classification system consisting of six interrelated classification structures. The ASGC provides a common framework of statistical geography and thereby enables the production of statistics which are comparable and can be spatially integrated. These provide private hospital statistics with a ‘where’ dimension.
13 For further information about the ASGC refer to Australian Standard Geographical Classification (ASGC), Jul 2009 (cat.no. 1216.0).
International Classification of Diseases
14 The International Classification of Diseases (ICD) is the international standard classification for epidemiological purposes and is designed to promote international comparability in the collection, processing, classification, and presentation of health statistics. The classification is used to classify diseases and causes of disease or injury. The ICD has been revised periodically to incorporate changes in the medical field.
15 Principal diagnosis and procedure for admitted patients are reported in this collection using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision - Australian Modification, 6th edition (ICD-10-AM).
16 For further information about the ICD refer to WHO International Classification of Diseases (ICD).
17 Further information about the ICD-10-AM 6th edition can be found online.
Australian Refined Diagnosis Related Groups (AR-DRG)
18 In Australia, a system of Australian Refined Diagnosis Related Groups (AR-DRG) is used as a means of classifying patients for Casemix purposes. Casemix refers to the range and types of patients (the mix of cases) treated by a hospital or other health service. Each AR-DRG represents a class of patients with similar clinical conditions requiring similar total hospital resources for their treatment. This provides a way of describing and comparing hospitals and other services for management purposes.
19 This classification is used by most states and territories as a management tool for public hospitals and, to varying degrees, for their funding. The classification is becoming more widely used by private hospitals as a reporting tool. Some contracting between health funds and private hospitals is gradually incorporating charging for patients based on their Casemix classification.
20 The ABS uses this classification to produce tables that provide data on major diagnostic categories. These tables are available on the ABS website in the data cubes associated with this publication.
21 For further information about AR-DRG refer to the Australian Government Department of Health and Ageing (DoHA) website.
DAY HOSPITALS CATEGORIES
22 Free-standing day hospital facilities are classified by the main income earning activity of the centre. The four main types are general surgery, specialist endoscopy, ophthalmic and plastic/cosmetic. Plastic/cosmetic facilities were collected as a separate category for the first time in 2000-01. Other types of centres, including fertility and sleep disorder clinics, are included in a residual category.
CHAIN VOLUME MEASURES
23 Chain volume measures have been used in this publication to enable analysis of the changes to income and expenditure for private hospitals over time in 'real' terms. It is considered that these measures provide better indicators of movement in real income and expenditures than constant price estimates. Unlike constant price estimates, they take account of changes to price relativities that occur from one year to the next. Chain volume measures are derived by revaluing the original current price series of recurrent expenditure for private hospitals by a specifically compiled measure of price change. The reference period for the chain volume measure is 2008. In this publication the Laspeyres input cost index for hospitals was used. This was specifically designed to measure price change in hospital recurrent expenditures. The data are consistent with the Australian System of National Accounts, 2008-09 (cat. no. 5204.0).
24 Questionnaires are sent each year to all private hospitals in Australia for completion and return to the ABS. In addition to this, for a large proportion of hospitals, data on admitted patients is sent to the ABS by state and territory health authorities on behalf of hospitals.
25 The 2008-09 reference period saw an overall response rate of 89.9%, a drop of 2.4 percentage points compared to 92.3% in 2006-07. Acute and psychiatric hospitals decreased slightly from 93.4% in 2006-07 to 92.8% in 2008-09 while Free standing Day Hospitals dropped considerably from 91.1% in 2006-07 to 87.0% in 2008-09.
26 Non-responding establishments were contacted both by telephone and follow-up letters in order to obtain the information required for the collection.
27 Response rates may have been impacted by the absence of a collection cycle in 2007-08, with a number of aspects potentially contributing to the observed decrease:
- births of units to the frame (in particular, the 33 new free-standing day hospitals in the 2008-09 reference period) introducing new providers unfamiliar with the collection;
- deaths of units from the frame during the 2007-08 reference period removing providers who were familiar with the collection;
- death of units from the frame during the 2008-09 reference period where the provider was no longer contactable;
- staff turnover over the two years resulting in loss of continuity and expertise in completing the forms.
Establishments which provided incomplete data were contacted to obtain the missing details. Hospital staff were asked to provide estimates in cases where records for the data items were not kept. If reasonable estimates could not be provided by the establishment then the data item was either left blank or imputed by ABS staff.
Establishments which did not respond had all data items imputed by ABS staff.
The imputation strategy employed for the 2008-09 reference period utilised historical and donor imputation; imputation was based on data received in previous years (historical) and/or on the results of the data provided by all responding hospitals of the same type, state/territory and size (donor). Data from state or territory health authorities was also used to supplement the imputation of the collection data provided the establishments gave consent.
Imputation rates were higher for the 2008-09 reference period compared to the 2006-07 period. A small proportion of units required full imputation in the 2008-09 reference period, which was lower in comparison to 2006-07. In the 2008-09 reference period, the majority of units requiring imputation were partial respondents thereby lessening the impact of imputation on the quality of data for these units.
Reliability of data
As the Private Health Establishments Collection does not have a sample component, the data is not subject to sampling variability. However, the statistics from the collection are subject to non-sampling errors which affect the data. These non-sampling errors may arise from a number of sources, including:
- errors in reporting of data by respondents (eg misunderstanding of questions or unwillingness of respondents to reveal all details);
- errors in capturing or processing of the data (e.g. coding, data recording);
- estimation for missing or misreported data;
- definition and classification errors.
Every effort is made to reduce errors in the collection to a minimum by careful design of questionnaires and processing procedures designed to detect errors and enable them to be corrected. These procedures include:
Hospital Morbidity Data
- external coverage checks;
- clerical and computer editing of input data;
- error resolution including referral back to the source;
- clerical scrutiny of preliminary aggregates;
Hospital morbidity data, providing admitted patient's details such as age, principal diagnosis and procedure, are routinely provided by hospitals to state and territory health authorities. Arrangements were made, with consent of the hospitals, for state and territory health authorities to provide the ABS with the relevant morbidity data. Any significant inconsistencies between the data collated by health authorities and by hospitals were followed up and resolved. As a result of this reconciliation of the 2008-09 data, the final total for patient separations was 2.2% higher than that reported by consenting hospitals and 2.3% higher than that compiled from data supplied by state and territory health authorities.
The percentage of hospitals for which hospital morbidity data was supplied to the ABS by state and territory health authorities was 95% for Acute and psychiatric hospitals and 86% for Free-standing day hospital facilities. Due to data quality issues and failure of an establishment to provide patient data to the relevant state or territory health authority, two smaller jurisdictions were unable to provide hospital data to the ABS for Free-standing day hospitals in the 2008-09 reference period.
Differences in accounting policy and practices lead to some inconsistencies in the financial data provided by hospitals. Measurement of expenditure is affected by management policy on such things as depreciation rates, bad debt and goodwill write-off. Further inconsistency occurs in cases where all property and fixed assets accounts are administered by a parent body or religious order headquarters and details are not available for the individual hospitals.
SPECIFIC ISSUES FOR 2008-09 DATA
'Other personal care staff' was excluded from the staffing categories collected for the financial year 2006-07, and was therefore not included in Full-Time Equivalent (FTE) and Wages and Salary data. However, these staff have been included in the 2008-09 collection and included in the 'Other staff' category.
The data presented for the private hospital sector in 2008-09 have been compared across a two year time difference (i.e. from 2006-07 to 2008-09). Data from previous private hospital collections have been presented as annual movements.
Acquisitions in the private health sector have resulted in, and will continue to further, changes to the number of hospitals operated by several large organisations. Ownership by some companies of a large proportion of acute and psychiatric hospitals has impacted on the amount of data that can be released by state for Tasmania, Northern Territory and Australian Capital Territory combined.
During the 2008-09 reference period, two establishments changed sector. There were a total of 30 closures and 37 new establishments.
EFFECTS OF ROUNDING
Where figures have been rounded, discrepancies may occur between totals and sums of the component items.
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