EXPLANATORY NOTES
INTRODUCTION
1 This publication contains statistical information for the 2012-13 financial year and selected 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 psychiatric hospitals and private 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 2012-13.
3 The data presented in this publication are supported by a series of data cubes 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 for the 2008-09 reference period.
5 Data presented in this publication for the 2012-13 reference period have been compared with data from the 2011-12 reference period and in some cases with the 2002-03 reference period.
6 A Glossary is provided detailing definitions of terminology used within this publication and the associated data cubes.
SCOPE
7 All private Acute and psychiatric hospitals licensed by state and territory health authorities and all private Day hospital facilities approved by the Australian Government 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.
COVERAGE
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.
DEFINITIONS
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.
CLASSIFICATIONS
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 2011-12 and 2012-13 publications only provide geographical data using a Metro and Rural classification, which is constructed from the ASGS.
15 A change was made to the method of determining the Metro and Rural classifications in 2011-12. The change had a small impact on the number of hospital establishments classified as Metro and Rural. The revised method classifies establishments in centres such as Townsville and Albury as Metro where before they were classified as Rural. The reason for the revision was that it is considered that these hospitals operate more like hospitals in metropolitan areas than hospitals in rural areas.
16 For further information about the ASGS refer too Australian Statistical Geography Standard (ASGS), Jul 2011 (cat.no. 1270.0.0.55.001).
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 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).
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 Mental Health section on the Australian Government Department of Health website.
DAY HOSPITAL CATEGORIES
25 Private 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 and 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. 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 2009. 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, 2012-13 (cat. no. 5204.0).
METHODOLOGY
27 Web forms are made available to all private hospitals in Australia each year. Paper questionnaires are still available on demand, should the web form not be suitable, for completion and return to the ABS. 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.
DATA QUALITY
Response Rate
28 The 2012-13 reference period saw an overall live response rate of 96.3%, a slight increase compared with 96.1% in 2011-12. Acute and psychiatric hospitals remained unchanged at 97.5% in 2012-13, while private Day hospital facilities increased to 95.3% in 2012-13 from 94.9% in 2011-12.
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. If reasonable estimates could not be provided by the establishment, the data item was imputed by ABS staff.
31 Establishments that did not respond to the collection had all data items imputed by ABS staff.
32 The imputation strategy employed for the 2012-13 reference period 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 reporting of data by respondents (e.g. 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 mis-reported data;
- definition and classification errors.
34 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:
- 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
35 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.
36 The percentage of hospitals for which hospital morbidity data was supplied to the ABS by state and territory health authorities was 89%. Due to data quality issues, two smaller jurisdictions were unable to provide hospital data to the ABS for private Day hospital facilities in the 2012-13 reference period.
Accounting Practices
37 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.
Ownership
38 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 the data for them has been combined. 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.
SPECIFIC ISSUES FOR 2012-13 DATA
39 The questions relating to accreditation in the 2012-13 private hospital collection referred to several non-current accrediting agencies and standards. Data have been allocated to current standards and agencies using provider feedback and information from industry sources. Hospitals that reported accreditation against
Benchmark Certification were allocated to
the BSI Group, those reporting against Business Excellence Australia were allocated to SAI-Global Ltd
and those reporting Quality Improvement Council accreditation were allocated to Quality Innovation Performance. The 2013-14 form has been updated and a process put in place to ensure this question uses up-to-date standards and agencies in the future.
40 Gross and net capital expenditure was not released in Private Hospitals, Australia, 2011-12. A number of factors, including the introduction of an electronic form, highlighted potential quality issues with historical reporting of capital expenditure. The introduction of the new electronic form improved the quality of the data. For example, reporting of whole dollars instead of thousands of dollars was less likely to occur. The analysis showed there were no quality issues with the 2011-12 results, but did highlight quality issues with 2010-11 data. Accordingly, it has been decided to re-release selected 2010-11 gross capital expenditure data (along with the 2011-12 gross capital expenditure) in 4390.0 - Private Hospitals, Australia, 2012-13.
41 The ABS has been working with hospital providers, and in particular private Day hospital facilities, to improve the reporting of private hospital activities and finances. This is an ongoing process and improved estimates may contribute to some of the movement in aggregate estimates.
EFFECTS OF ROUNDING
42 Some figures 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.
ACKNOWLEDGEMENT
43 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.
RELATED PUBLICATIONS
44 Other ABS publications that may be of interest include:
45 The following related publications are issued by other organisations.
- Available from the Australian Institute of Health and Welfare (AIHW) website:
Australian Hospital Statistics, 2011-12
Australia's Health, 2012
Australian Health Expenditure by Remoteness; A comparison of remote, regional and city health expenditure, 2011
Health Expenditure Australia, 2010-11
Health and Community Services Labour Force, 2006 - Produced jointly with ABS
Medical Labour Force, 2010
National Health Data Dictionary, Version 16, 2012
National Report on Health Sector Performance Indicators 2008
Nursing and Midwifery Labour Force, 2009
- Available from the Mental Health and Wellbeing in Australia website:
National Mental Health Report, 2013
National Mental Health Report, 2007: Summary of Twelve Years of Reform in Australia's Mental Health Services under the National Mental Health Strategy 1993-2005
- Available from the Private Health Insurance Administration Council, Canberra (PHIAC) website:
PHIAC A Reports - Released quarterly
Statistical Trends in Membership and Benefits - Released quarterly
46 ABS products and publications are available free of charge from the
ABS website. To review the full range of ABS statistical and reference information, go to the ABS Home Page. For details on products scheduled for release in the coming week, find on the Upcoming Product Releases link on the ABS home page.
ABS DATA AVAILABLE ON REQUEST
47 As well as the statistics included in this and related publications, the ABS may have other relevant data available. Inquiries should be directed to the National Information and Referral Service on 1300 135 070 or by email to client.services@abs.gov.au.
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