1 This publication contains statistical information for the 2015-16 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 series of Australian Hospital Statistics publications.
3 The data presented in this publication are supported by a series of data cubes to be made 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 from the 2008-09 reference period.
5 Data presented in this publication for the current reference year have been compared with data from the previous reference year and in some cases with earlier reference years.
6 A glossary is provided in this publication for 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 (DoH) for the purpose of health insurance benefits, including those registered with their respective state health authority, 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 that 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 provided in this publication for further definitions of the data items used.
Australian Standard Geographical Classification (ASGC)
12 The ASGC was an hierarchical classification system consisting of six interrelated classification structures. It provided a common framework of statistical geography and thereby enabled the production of statistics which were comparable and could be spatially integrated. These provided private hospital statistics with a ‘where’ dimension. The 2010-11 private hospitals collection was the last to provide estimates using the ASGC.
Australian Statistical Geography Standard (ASGS)
13 The ASGS replaced the ASGC from 1 July 2011. It brings all the regions for which the ABS publishes statistics within the one framework and is used by the ABS for the collection and dissemination of geographically classified statistics. It is the framework for understanding and interpreting the geographical context of statistics published by the ABS. The ABS also encourages the use of the ASGS by other organisations to improve the comparability and usefulness of statistics generally.
14 The 2010-11 private hospitals publication presented data on both an ASGC and an ASGS basis. The current publication only provides geographical data using the ASGS.
15 The current publication also provides sub-state data by metro-rural classification data (using the ASGS classifications of Section of State and Remoteness area). Metro refers to all the state and territory capitals and areas such as Albury, Geelong and Townsville.
16 For further information about the ASGS refer to Australian Statistical Geography Standard (ASGS) (cat.no. 12184.108.40.206.001).
International Classification of Diseases
17 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.
18 Principal diagnosis and procedures 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).
19 For further information about the ICD refer to WHO International Classification of Diseases (ICD).
20 Further information about the ICD-10-AM 6th edition can be found online.
Australian Refined Diagnosis Related Groups (AR-DRG)
21 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.
22 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.
23 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.
24 For further information about AR-DRG refer to the Australian Government Department of Health (DoH) website.
DAY HOSPITALS CATEGORIES
25 Free-standing day hospital facilities are classified by the main income earning activity of the centre. Until 2009-10, the four main types were general surgery, specialist endoscopy, ophthalmic & plastic/cosmetic, as well as a residual "Other" category. The increasing proportion of the hospitals that were reporting in the residual category led the ABS to include six additional activities as of the 2010-11 collection. The new activities were Gynaecology, Dental, oral and maxillofacial, Oncology, Dialysis, Fertility treatment, and Family Planning. In addition, Specialist endoscopy is now included in a broader category, Gastroenterology. Other types of hospitals, for example sleep disorder clinics, are included in the residual category.
CHAIN VOLUME MEASURES
26 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. These take into account price relativities (or weights) that occur from one year to the next. Chain volume measures are derived by revaluing the original current price series of income and recurrent expenditure for private hospitals by a specifically compiled measure of price change. In this publication the Laspeyres input cost index for hospitals was used. This was specifically designed to measure price change in hospital income and recurrent expenditures. The data are consistent with the Australian System of National Accounts (cat. no. 5204.0).
27 Unit Identifiers and Passwords are provided each year to all private hospitals in Australia to enable them to login and complete the questionnaire online. (Paper forms are provided when requested.) In addition to this, for the majority of hospitals, data on admitted patients is provided to the ABS by state and territory health authorities on behalf of hospitals. For this latter component, the ABS seeks consent from hospitals to obtain the data from the authorities.
28 The 2015-16 reference period saw an overall live response rate of 97.5%. The response for Acute and psychiatric hospitals was 97.6% and for Free-standing day hospitals the response rate was 97.4%.
29 Non-responding establishments were contacted both by telephone and follow-up letters in order to obtain the information required for the collection.
Imputation for non-response or missing data
30 Establishments that 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 or unavailable. If reasonable estimates could not be provided by the establishment, the data item was imputed by ABS staff.
31 Establishments which did not respond to the collection had all data items imputed by ABS staff.
32 The imputation strategy employed utilised historical and donor imputation; 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 were also used to supplement the imputation of the collection data, provided the hospitals consented .
Reliability of data
33 As the Private Health Establishments Collection does not have a sample component, the data are 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 online reporting or keying of data by respondents (including errors due to misunderstanding of questions or unwillingness of respondents to reveal all details);
- errors in capturing or processing of the data;
- estimation for missing or mis-reported 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 to ensure all private hospitals are included;
- clerical and computer editing of input data;
- error resolution including referral back to the source;
- clerical scrutiny of preliminary aggregates and confronting them with external data sources.
Hospital morbidity data, providing admitted patients 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.
The percentage of hospitals for which hospital morbidity data was supplied to the ABS by state and territory health authorities was around 90%. Due to data quality issues, two smaller jurisdictions are unable to provide hospital data to the ABS for Free-standing day hospitals.
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.
Each year, acquisitions in the private health sector result in 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 impact on the amount of data that can be released by state for Tasmania, Northern Territory and Australian Capital Territory, so these data are aggregated. Consequential analysis results in the necessary suppression of other states' data. In a similar way and for the same reason, some of the more detailed data items are confidentialised to protect the small number of establishments that contribute to the data.
NOTES, INCLUSIONS & EXCLUSIONS
Over the past several years, the ABS has worked with hospital providers to improve the collection form, with the aim of ensuring what is required from the collection is clear and that the questions align with the way hospitals account for their activities and finances. As a result, additional information was added to some questions and to some Notes, Inclusions and Exclusions.
EFFECTS OF ROUNDING
40 Some data have been rounded and, as a result, discrepancies may occur between totals and sums of the component items. Rounding may also cause discrepancies between publication tables and data represented in the respective data cubes.
41 ABS publications draw extensively on information provided by individuals, businesses, governments and other organisations. Their continued cooperation is very much appreciated. Information received by the ABS is treated in strict confidence as required by the Census and Statistics Act 1905.
42 For other ABS publications of interest see the 'related information' tab in this publication
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ABS DATA AVAILABLE ON REQUEST
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