Private hospital service provision APHA facts on private hospitals

About this document Private hospitals provide a wide range of services and are an integral part of the Australian health system. For patients, it is important to have a range of choice, so it is possible to opt for the delivery of care that is best for them. The following information describes the services provided by the private hospitals sector in Australia.

Private hospitals Provide 2 in 5 hospitalisations (40%) in Australia Employ 69,299 FTE staff including 38,297 FTE nurses Had an income of $15.5 billion and capital expenditure of $0.8 billion All data for 2016-17 AIHW 2018. Admitted patient care 2016–17: Australian hospital statistics. ABS 4390.0 - Private Hospitals, Australia, 2016-17. FTE and $ (Acute and Psych + Free Standing Day Only)

Admitted patient care Private hospitals treat 2 in 5 (40%) of all patients in Australia account for 1 in 3 (32%) of all patient days In 2016–17, private hospitals accounted for a total of 4,426,467 out of 11,013,815 separations (AIHW 2018:13). These included emergency and non-emergency separations, acute, sub-acute and non-acute separations. These figures include over-night and same-day separations but exclude services classified as ‘out-patient’ or ‘non-admitted’ services. In 2016–17, private hospitals and day surgeries provided - 3,136,015 same-day hospitalisations (47% of all same-day hospitalisations) (AIHW 2018:15) - 1,290,452 overnight hospitalisations (30% of all overnight hospitalisations) (AIHW 2018:15). Admitted patient care, involves: “Admission to hospital [which] is a formal process, and follows a decision made by a medical officer that a patient needs to be admitted for appropriate management or treatment of their condition, or for appropriate care or assessment of needs.” (AIHW 2013:12) For statistical purposes, the Australian Instituted of Health and Welfare describes the quantum of admitted patient care provided in any one year in terms of “separations” occurring in that period. “Separation is the term used to refer to the episode of admitted patient care, which can be a total hospital stay (from admission to discharge, transfer or death) or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute care to rehabilitation). Separation also means the process by which an admitted patient completes an episode of care by being discharged, dying, being transferred to another hospital or by a change of care type.” The data presented in this chart does not include out-patient/non-admitted patient care “Out-patient/Non-admitted patient: a patient who receives care from a recognised non-admitted patient service/clinic of a hospital.” (AIHW 2013:114)  

Service categories Private hospitals and day surgeries provide the following broad categories of service: This chart shows the proportion of total separations (same-day and overnight) provided by private hospitals in each broad category of services in 2015–16. (AIHW 2017:103, 106-7) These services are defined by the AIHW as follows: “Surgical: separations for which the AR-DRG belonged to the Surgical partition (involving an operating room procedure), excluding separations for Childbirth and Specialist mental health. “Medical: separations for which the AR-DRG belonged to the Medical partition (not involving an operating room procedure), excluding separations for Childbirth and Specialist mental health. “Other: separations for which the AR-DRG did not belong to the Surgical or Medical partitions (involving a non-operating room procedure, such as endoscopy), excluding separations for Childbirth and Specialist mental health. “Specialist mental health: separations for which specialised psychiatric care days were reported, excluding separations for Childbirth. “Childbirth: separations for which the AR-DRG was associated with childbirth (does not include newborn care).” (AIHW 2013:136)

Private hospital patient cohorts This chart shows the principal source of funds for the admitted patient episode (same-day and overnight) in private hospitals in 2016–17. (AIHW 2018:241) NOTE: data for ACT not included. “Public patients: includes separations for Medicare-eligible patients who elected to be treated as a public patient and separations with a funding source of Reciprocal health care agreements, Other hospital or public authority (with a public patient election status) and No charge raised (in public hospitals). The majority of separations with a funding source of No charge raised (in public hospitals) were in Western Australia, reflecting that some Public patient services were funded through the Medicare Benefit Schedule.” “ Other: includes separations with a funding source of Other compensation, Department of Defence, Correctional facilities, Other hospital or public authority (without a Public patient election status), Other, No charge raised (in private hospitals) and not reported.”   The above figures do not include care provided to the outpatient/non-admitted patients.

Service provision In 2016–17, private hospitals provided procedures and treatments for 801(99%) of the 807 Australian Refined Diagnostic-Related Groups (AR-DRGs). The 6 treatments not performed in private hospitals in 2016–17 included: Neonatal diagnosis not consistent with age/weight Liver transplants Heart, lung or heart-and-lung transplants Allogeneic bone marrow transplant (younger than 16 or major complexity) Cardiothoracic and vascular procedures for neonates. Based on AR-DRGs reported to Private Hospital Data Bureau (PHDB Annual Report 2015-16; available http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-publications-PHDBAnnualReports); AR-DRG version 8.0 contains a total of 807 DRGs (including 3 error DRGs). List of all v8.0 AR-DRGs sourced from The Australian Consortium for Classification Development (ACCD; https://www.accd.net.au/Downloads.aspx)

Elective surgery In 2016–17, private hospitals and day surgeries treated 1,489,173 of 2,237,556 (67%) of elective admissions involving surgery (AIHW 2018:200). “Elective admissions involving surgery are identified as separations with a ‘surgical AR-DRG’ in AR-DRG version 7.0 (NCCC 2012), and for which the urgency of admission was reported as Elective—indicating that admission could be delayed beyond 24 hours. They do not include separations where the urgency of admission was Not assigned or was not reported. For the first time, surgical separations for childbirth separations and subacute and non-acute separations are included in elective admissions involving surgery. Therefore, these data are not comparable with data in earlier reports. The elective admissions involving surgery using admitted patient care data from the NHMD are not necessarily the same as elective surgery as defined for the National Elective Surgery Waiting Times Data Collection (NESWTDC). This is due to several factors including: • the data in the NESWTDC relate to patients who were admitted from public hospital waiting lists, whereas the elective admissions involving surgery sourced from the NHMD include patients who were not placed on a waiting list, including in private hospitals • surgical AR-DRGs and the NESWTDC are defined using a different list of procedures. For example, more than 70% of admissions from public hospital elective surgery waiting lists for Cystoscopy (defined as a surgical procedure for the NESWTDC) were assigned to various non-surgical AR-DRGs including L41Z–Cystourethroscopy for urinary disorder, same-day (41%) and Z40Z–Other contacts with health services with endoscopy, same-day (17%). • the data in the NESWTDC can include separations for which the urgency of admission was Emergency.” -AIHW APC 2017:181 Private hospitals and day surgeries perform 2 in 3 elective surgeries in Australia

Acute surgery In 2016–17, 2,605,855 hospitalisations with a surgery procedure reported were defined as acute care (surgery required within 24 hours). 1,544,987 of those (59%) occurred in private hospitals. (AIHW 2018:16) Private hospitals and day surgeries perform 3 in 5 acute surgeries in Australia

Eye surgery Private hospitals and day surgeries perform 3 in 4 eye surgeries. In 2016–17, private hospitals and day surgeries provided 73% of all procedures on the eye and adnexa. AIHW 2018:164

Cardiac procedures Private hospitals and day surgeries perform nearly half (48%) of all heart surgeries in Australia. In 2016–17, private hospitals provided 287,332 out of 597,808 (48.1%) cardiovascular procedures. (AIHW 2018:164) A ‘procedure’ is defined by the AIHW as : “a clinical intervention that is surgical in nature, carries a procedural risk, carries an anaesthetic risk, requires specialised training and/or requires special facilities or equipment available only in an acute care setting.” (AIHW 2013:330) A surgical procedure is a procedure used to define surgical AR-DRGs in version 6.0x (AIHW 2013:333) Note: the above figures do not include cardiology care provided to the outpatient/non-admitted patients, by outpatient clinic type, in public and/or private hospitals.

Rehabilitation services Private hospitals treat over 3 in 4 people admitted for rehabilitation. In 2016–17, private hospitals treated 349,934 out of 444,975 (78.6%) rehabilitation hospitalisations. (AIHW 2018:130) Admitted patient data do not cover all rehabilitation work in Australia. Care type: the care type defines the overall nature of a clinical service provided to an admitted patient during an episode of care (admitted care), or the type of service provided by the hospital for boarders or posthumous organ procurement (other care). Admitted patient care consists of the following categories: Acute care Rehabilitation care Palliative care Geriatric evaluation and management Psychogeriatric care Maintenance care Newborn care Other admitted patient care—this is where the principal clinical intent does not meet the criteria for any of the above. Other services include: Posthumous organ procurement Hospital boarder (AIHW 2013:323–4) The Consultative Committee on Private Rehabilitation (CCPR) has developed the Minimum Requirements for Private Hospital-Based Rehabilitation Services (the Minimum Requirements). The Guidelines are intended to provide guidance to hospitals and health funds in determining private health insurance benefits for private hospital-based rehabilitation care. Guidelines for Recognition of Private Hospital-Based Rehabilitation Services

Psychiatric services Private psychiatric hospitals care for more than 39,000 people per year. In 2016–17, there were 65 private hospitals providing specialist psychiatric services in Australia: 32 were stand–alone private psychiatric hospitals and 33 were private general hospitals that had psychiatric units. Together these hospitals had approximately 3,047 psychiatric beds Data were collected for all 64 of these hospitals. Private hospitals admitted 39,328 patients for psychiatric care. Of those patients, 29,900 had a total of 45,048 separations for overnight inpatient care (excluding brief overnight admissions for same-day procedures) with an average length of stay of 19 days. For the 19,321 patients who received any care on a Same-day or Outreach basis the average number of days of care per patient was 13. Of those patients seen in the Ambulatory Care service setting 9,893 also had at least one overnight inpatient admission   Because of differences in scope and methodology it is not possible to directly compare these figures with those published by the AIHW. Source: PPHDRAS Annual Statistical Report for the 2016-17 Financial Year. Prepared 23/03/2018.

Serving older Australians 4.6 million separations related to patients aged 65 and over. private hospitals treated more than 2 in 5 of those patients (44%, or more than 2 million) (AIHW 2018:50). People aged 65 and over represented 42% of all hospital admissions. In the private hospital sector, this proportion was slightly higher, at 46%. 754,073 separations related to patients aged 85 and over. Private hospitals treated 38% of those patients (288,719) (AIHW 2018:52). People aged 85 and over represented 6.8% of all hospital admissions. In the private sector, this proportion was 6.5%. Private hospitals and day surgeries treat more than 2 in 5 hospitalisations where the patient is aged 65 or older.

Serving Australian veterans In 2016–17, private hospitals treated 165,633 of 244,468 (68%) of Department of Veterans’ Affairs patients (AIHW 2018:241) The above figures do not include care provided to the outpatient/non-admitted patients in public or private hospitals. Private hospitals and day surgeries admit 2 in 3 veterans who need treatment.

Sources ABS (Australian Bureau of Statistics) 2018. Private hospitals, Australia, 2016–17. ABS cat. no. 4390.0. Canberra: ABS. AIHW (Australian Institute of Health and Welfare) 2018. Admitted patient care 2016–17: Australian hospital statistics. Health services series no. 84. Cat. no. HSE 201. Canberra: AIHW. PHDB Annual Report 2016–17. Available: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-casemix-data-collections-publications-PHDBAnnualReports PPHDRAS Annual Statistical Report: Private Hospital-based Psychiatric Services 2016-17.