Private Hospitals, Australia methodology

Hospitals that are accredited/certified by the Australian Council on Healthcare Standards (ACHS), Global Mark Pty Ltd, SAI-Global (previously Business Excellence Australia) or any other body approved for private sector quality criteria certification or ISO quality family standards. Participation in these schemes is voluntary and accreditation is awarded when hospitals demonstrate a continuing adherence to quality assurance standards. Hospital accreditation/certification is regarded as one of the few indicators of hospital quality that is available nationally.

These provide at least minimal medical, surgical or obstetrical services for admitted patient treatment and/or care and provide round-the-clock comprehensive qualified nursing services as well as other necessary professional services. They must be licensed by the state or territory health authority. Most of the patients have acute conditions or temporary ailments.

An admitted patient undergoes a hospital's formal admission process. See also Patient.

These are provided by units and clinics for the treatment and counselling of patients. They mainly comprise physiotherapy, speech therapy, family planning, dietary advice, optometry and occupational therapy.

An Australian patient classification system compromising a description of body systems, a separation of medical and surgical procedures, and a description of a hierarchy of procedures, medical problems and other factors that differentiate processes of care (Australian Government Department of Health).

The ASGC provided a common framework of statistical geography and thereby enabled the production of statistics which were comparable and can be spatially integrated. This publication no longer uses the ASGC.

The ASGS replaces the ASGC. In this publication, metro-rural is the only sub-state classification (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.

Available beds are those immediately available (occupied and unoccupied) for the care of admitted patients as required. In the case of Free-standing day hospital facilities, they include chairs, trolleys, recliners and cots and are used mainly for post-surgery recovery purposes only. See also Beds and Occupied beds.

This is calculated by dividing the aggregate number of patient days by the number of separations associated with those patient days.

These are provided for the care and treatment of admitted (same-day and overnight-stay) patients. See also Available beds and Occupied beds.

Refers to expenditure on acquisition or enhancement of an asset (excluding financial assets). Examples are: expenditure on land and buildings, computer facilities, major medical equipment, plant and other equipment, and expenditure in relation to intangible assets, having regard to guidelines followed as to the differentiation between capital and recurrent costs.

Constant price estimates 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. See Explanatory note 25 for further information.

A bona fide emergency department is a department that provides levels 4 to 6 of emergency services as defined by the current guide to the Role Delineation of Health Services, 3rd edition, New South Wales, Department of Health, 2002. Six levels of emergency services roles are identified:

Level 0 - No service
Level 1 - No planned emergency service
Level 2 - Emergency service in small hospital. Designated assessment and treatment area. Visiting medical officer on call.
Level 3 - As Level 2 plus designated nursing staff available 24 hours. Has 24 hour access to medical officer(s) on site or available within 10 minutes. Specialists in general surgery, anaesthetics, paediatrics and medicine available for consultation. Full resuscitation facilities in separate area.
Level 4 - As Level 3 plus can manage most emergencies. Purpose designed area. Full-time director. Experienced medical officer(s) and nursing staff on site 24 hours. Specialists in general surgery, paediatrics, orthopaedics, anaesthetics and medicine on call 24 hours.
Level 5 - As Level 4 plus can manage all emergencies and provide definitive care for most. Has undergraduate teaching and undertake research. Has designated registrar. May have neurosurgery service.
Level 6 - As Level 5 plus has neurosurgery and cardiothoracic surgery on site. Sub-specialists available on rosters. Has registrar on site 24 hours.

These factors relate to occasions when circumstances other than a disease, injury or external cause are recorded as "diagnoses" or "problems". This can arise in two main ways:

• when a person who may or may not be sick encounters the health services for some specific purpose, such as to receive limited care or service for a current condition, to donate an organ or tissue, to receive prophylactic vaccination or to discuss a problem which is in itself not a disease or injury;
• when some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury.
   

'Not for profit' hospitals are those which qualify as a non-profit organisation with either the Australian Taxation Office (ATO) or the Australian Securities and Investments Commission. These are further categorised as 'Religious or charitable' and 'Other' (comprising bush nursing, community and memorial hospitals). All other hospitals are classed as 'For profit'.

The list of units available for selection in a census or sample survey. In this case, all licensed private hospitals operating during the reference period comprise the frame. This list is supplied by the State and Territory Health Authorities (SHAs) and the Department of Health (DoH).

These provide investigation and treatment for acute conditions on a day-only basis and are approved by the Commonwealth for the purposes of basic table health insurance benefits.

Full-time equivalent staff represent the sum of full-time staff and the full-time equivalent of part-time staff during the last week of the pay period ending on of before 30 June, or for a typical week of hospital operation. It is derived by adding the on-job hours worked and hours of paid leave (sick, recreation, long service, workers' compensation leave) by/for a staff member divided by the number of hours normally worked by a full-time staff member when on the job under the relevant award or agreement. See also Staff.

Gross capital expenditure refers to expenditure in a period on the acquisition or enhancement of an asset (excluding financial assets), such as buildings and building construction, information technology, major medical equipment and transport.

International Statistical Classification of Diseases and Related Health Problems. The purpose of the ICD is to permit the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. The ICD, which is endorsed by the World Health Organisation (WHO), is primarily designed for the classification of diseases and injuries with a formal diagnosis. Further information is available from the WHO web site www.who.int.

Three main categories of income are identified:

Patient income includes income/revenue received by, and due to, the hospital in respect of patient liability for accommodation and other fees (including for prostheses), regardless of source of payment (Commonwealth, state and local government, private health fund, insurance company, direct from patient, payment from third parties such as Workcover payments) or status of patient (whether admitted or non-admitted patient). Excluded is GST.

Recoveries include income received from rental of hospital facilities including facility fees paid by medical practitioners, meals and accommodation for staff, TV, telephone and Internet fees. Income for extraordinary items, GST, and Australian Government Paid Parental Leave Scheme are excluded.

Other income includes income received from car parks, sales of goods and services, sponsorship and fundraising, interest/investment, dividends, meals and accommodation for visitors, sundry income, net profit (or loss) on the sale of assets. Income for extraordinary items, GST, and Australian Government Paid Parental Leave Scheme are excluded as are payments received from state or territory governments.

Includes employer contributions into superannuation funds, workers' compensation premiums/costs, payroll tax, wages and salaries including provisions for employee entitlements, contract payments for medical services.

Net capital expenditure refers to gross capital expenditure less disposals of capital assets items such as buildings and building construction, information technology, major medical equipment and transport.

Net operating margin is derived by subtracting recurrent expenditure from income and expressing the result as a proportion of income.

Any services provided to a non-admitted patient in a functional unit (e.g. radiology) of the hospital. Each diagnostic test or simultaneous set of related diagnostic tests is counted as one occasion of service.

The number of occupied beds is calculated by multiplying the number of average available beds by the occupancy rate. See also Beds, Available Beds, and Bed Occupancy Rate.

Includes staff services, accommodation, bedding and linen, hardware, crockery, cutlery, laundering and cleaning of uniforms.

Includes neurosurgical unit, acute spinal cord injury unit, burns unit, major plastic/reconstructive surgery unit, transplantation units, acute renal dialysis unit, infectious diseases unit, comprehensive epilepsy centre, clinical genetics unit, AIDS unit, diabetes unit, in-vitro fertilisation unit, post-acute rehabilitation units and other specialised services.

A patient is a person for whom a hospital accepts responsibility for treatment and/or care.

An admitted patient undergoes a hospital's formal admission process. Babies born in hospital are excluded unless they are provided with medical care other than that which would normally be provided to a newborn, or they remain in hospital after the mother has been discharged, or are the second or subsequent live born infant of a multiple birth and the mother is currently an admitted patient. Persons accompanying a sick patient (e.g. nursing mothers and parents accompanying sick children) are also excluded. 

Overnight-stay patients are admitted to and separated from hospital on different dates (i.e. they stay at least one night in hospital).

Same-day patients are admitted and separated on the same day (i.e. they are in hospital for a period that does not include an overnight stay).

Non-admitted patients do not undergo a hospital's formal admission process. These include outpatients, accident and emergency patients and off-site (community/outreach) patients.

These are the aggregate number of days of stay (i.e. calculated as separation date minus admission date) for all overnight-stay patients who were separated from hospital during the year. Periods of approved leave are subtracted from these calculations. Same-day patients are each counted as having a stay of one day.

Includes revenue received by, and due to, the hospital in respect of patient liability for accommodation and other fees, regardless of source of payment (Commonwealth, health fund, insurance company, direct from patient) or status of patient (whether admitted or non-admitted patient). It does not include recoveries (i.e. income received from items such as staff meals and accommodation, and facility fees paid by medical practitioners) or Other income (i.e. income such as investment income from temporarily surplus funds and income from charities, bequests, meals and accommodation provided to visitors, and kiosk sales).

Indicates whether or not hospital insurance is held by a patient through a registered health insurance fund, or a general insurance company. Patients who have insurance cover only for ancillary services are regarded as not having hospital insurance.

Occurs when an admitted patient:

• is discharged
• is transferred to another institution
• leaves against medical advice
• dies whilst in care
• changes their type of care from/to acute, rehabilitation, palliative or non-acute care (known as statistical discharge), or
• leaves hospital for a period of seven or more days.
   

A clinical intervention that:

• is surgical in nature; and/or
• carries a procedural risk; and/or
• carries an anaesthetic risk; and/or
• requires specialised training; and/or
• requires special facilities or equipment only available in an acute care setting.

For admitted patients, procedures undertaken during an episode of care are recorded in accordance with ICD-10-AM 6th edition.

A room in which medical or surgical procedures are conducted. Where multiple procedure bays or procedure chairs were available in one area or room, providers were asked to report on each bay/chair rather than on the room as a whole. This clarification has resulted in an increase in the number of procedure rooms/bays, sessions and times for some types of centres.

Psychiatric hospitals are licensed/approved by each state or territory health authority and cater primarily for admitted patients with psychiatric, mental or behavioural disorders.

Comprises expenditure on wages and salaries and other labour costs, drug, medical and surgical supplies, food supplies, domestic services, administrative expenses, fuel and power, purchases of finished goods, patient transport, repairs and maintenance, contract services, depreciation and amortisation, non-labour contract expenses and other recurrent expenditure. For further information refer to the National Health Data Dictionary which is available on the AIHW web site www.aihw.gov.au.

Includes costs of maintaining, repairing, replacing and providing additional equipment, maintaining and renovating buildings, and minor additional works.

Discharge from private hospital facility. See Patient Separation.

A facility or unit dedicated to the treatment or care of patients with particular conditions or characteristics.

Includes:

• Salaried medical professionals but excluding visiting/consulting medical officers.
• Diagnostic and health professionals, including qualified diagnostic health professionals, allied health professionals and laboratory technicians.
• Full time equivalent nursing staff, comprising registered nurses and enrolled nurses including nurses in operating theatres, labour wards, psychiatric units, alcohol and drug rehabilitation units, other special care units, and emergency department and units. Also included are staff employed by the hospital and contract staff employed through an agency in cases where the contract is for the supply of labour.
• Clinical support staff.
• Administrative and clerical staff, including computing staff, finance staff and civil engineers.
• Domestic and other staff includes staff, includes including trades people, maintenance staff and staff engaged in cleaning, laundry services, the provision of food.
   

This is how hospitals record situations where changes in the type of care patients are receiving occur but do not result in the patients actually leaving the hospital. It is recorded as a discharge but only for statistical purposes. Examples of these are when the type of care changes from/to acute, rehabilitation, palliative or non-acute care.

Free-standing day hospital centres are categorised by type according to their main economic activity. The ABS uses this question to understand both the range of activities undertaken by free-standing day hospitals and to monitor changes in the industry. This publication provides information on the most numerous income earning activities as well as aggregates of the other categories The following types of centres are separately categorised:

• general surgery
• gastroenterology
• ophthalmic
• plastic/cosmetic
• gynaecology
• dental, oral and maxillofacial surgery
• oncology
• dialysis
• family planning
• fertility treatment
• other.
   

Includes wages and salaries, superannuation employer contributions, payroll tax, workers' compensation and workcare premiums, uniforms, education, personnel costs and fringe benefits tax.

For information on the institutional environment of the Australian Bureau of Statistics (ABS), including the legislative obligations of the ABS, financing and governance arrangements, and mechanisms for scrutiny of ABS operations, please see ABS Institutional Environment.

The scope of the collection is:

• All private acute and psychiatric hospitals licensed by state and territory health authorities, and
• All free-standing day hospital facilities approved by the Commonwealth Department of Health for the purpose of health insurance benefits, including those registered with their respective state health authority, are within the scope of this collection.

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.

Coverage includes all private hospitals in Australia which operated for all or only part of the reference year are included in the collection. Updated lists of private hospitals are received throughout the year from state, territory and Commonwealth health authorities and every effort is made to include all hospitals in scope.

Private Hospitals data are published annually on a financial year basis, and are generally released within 12 months of the end of the reference period.

Non-sample errors are the main influence on accuracy in datasets which are a complete census of the population rather than a sample. Non-sample error arises from inaccuracies in collecting, recording and processing the data. The most significant of these errors are: mis-reporting of data items; deficiencies in coverage; non-response to particular questions; and processing errors.

Every effort is made to minimise error by working closely with data providers, the careful design of forms, training of processing staff, and efficient data processing procedures. The changes in form design in 2010-11, and the collection of data by web form from 2011-12, are aimed at helping providers to further improve the supply of complete and accurate data.

Establishments that provided incomplete forms were contacted to obtain the missing details. Hospital staff are asked to provide estimates in cases where records for the data item were not kept. If reasonable estimates could not be provided by the establishment then the data item was either left blank (and is therefore not available) or was imputed by ABS staff.

The response rate for the current collection was 96 per cent.

Use of the supporting documentation released with the statistics is important for assessing coherence within the dataset and when comparing the statistics with data from other sources. Changing business rules over time and/or across data sources can affect consistency and hence interpretability of statistical output. The Explanatory Notes in each issue contains information pertinent to this particular release which may impact on comparison over time.

The Private Hospitals publication contains detailed Explanatory Notes and Glossary that provide information on the data sources, terminology, classifications and other technical aspects associated with these statistics.

Changes to the collection over time are also noted in the Explanatory Notes of the relevant issue. The Private Health Establishment Collection was not conducted for the 2007-08 reference period due to the ABS budgetary constraints. This represents a break in the time series for the collection. The collection was reinstated for the 2008-09 reference period, has been conducted each year since then.

In addition to the information provided in this publication, a series of data cubes are also available providing detailed breakdowns by Acute and Psychiatric Hospitals and Free-standing Day Hospital Facilities. The ABS observes strict confidentiality protocols as required by the Census and Statistics Act (1905). This may restrict access to data at a very detailed level which is sought by some users.

There are relatively few psychiatric hospitals and some of these are owned by the same parent company. To maintain the confidentiality of their data, psychiatric hospitals are combined with acute hospitals in most tables in this publication. Any differences between data presented in this publication and the data shown in other reports on private hospital activity are due to differences in scope and coverage, relative completeness of the data sources and differing error procedures.

If the information you require is not available from the publication or the data cubes, then the ABS may also have other relevant data available on request. Inquiries should be made to the National Information and Referral Service on 1300 135 070 or by sending an email to client.services@abs.gov.au.