Summary

Between 2009–10 and 2016–17, national estimates of the number of private hospital admitted patient care separations reported through the Private Health Establishments Collection (PHEC)—collated by the Australian Bureau of Statistics (ABS) and published through its Private hospitals Australia reports—were consistently higher than the number of private hospital admitted patient care separations reported through the National Hospital Morbidity Database (NHMD), compiled by the AIHW and released in its Admitted patient care: Australian hospital statistics reports.

This report examines the differences between these 2 data sources in an attempt to understand the reasons for those differences. As the PHEC has now ceased, the report also aims to understand and identify any data gaps in the scope and coverage of the NHMD. This will assist analysts and policymakers in understanding how to interpret these data as they pertain to admitted patient activity for the private hospital sector in Australia. It will also identify potential areas in which the AIHW can work with data providers to reduce these data gaps.

Comparisons of private hospital estimates of the number of admitted patient care separations recorded in the PHEC from 2009–10 to 2016–17, compared with the number of admitted patient care separations recorded for that period in the NHMD, show that:

  • the PHEC rose from 3.7% higher than the NHMD in 2009–10 to 10.5% higher in 2016–17, with a sharp increase from 2012–13 onwards. The increase from 2012–13 onwards was due to an increase in the difference between PHEC and NHMD data for New South Wales and Victoria
  • the most significant discrepancies occurred with respect to separations from private free-standing day facilities. The discrepancy between NHMD and PHEC data for private free-standing day facilities increased from 9.8% in 2009–10 to 29.8% in 2016–17 and rose sharply from 10.7% in 2011–12 to 27.1% in 2012–13
  • for private hospitals other than private free-standing day facilities, the differences between NHMD and PHEC data rose from 1.9% in 2009–10 to 5.2% in 2016–17.

Comparisons between the PHEC for 2016–17, and the NHMD for that year, show that:

  • the ABS reported 46 more private hospitals than captured in the NHMD. The largest discrepancies were for Victoria and for the smaller states and territories (Tasmania, the Australian Capital Territory and the Northern Territory)
  • Victoria accounted for over 40% of the difference between NHMD and PHEC separations data for private hospitals
  • Victoria and New South Wales accounted for more than two-thirds of the difference between NHMD and PHEC separations data for private free-standing day facilities
  • For hospitals other than private free-standing day facilities, the greatest difference between NHMD and PHEC separations data for private hospitals was for Western Australia. This was largely attributable to differences in treatment between the two collections of privately owned and/or operated hospitals which undertake predominantly public activity
  • Differences in casemix between the PHEC and the NHMD for private free-standing day facilities seem to be related to the principal diagnosis and procedure chapters which include dialysis, chemotherapy and endoscopies—all types of episodes that can be treated either as ‘non-admitted’ or ‘admitted’ activity, depending on admission practices. This suggests that some activity that was included in the PHEC as admitted activity might not have been reported to the NHMD, as it was considered non-admitted activity by some jurisdictions (consistent with the way such care is delivered in their public hospital settings)
  • For private hospitals other than free-standing day facilities, differences in casemix between PHEC and NHMD data seem to be related to principal diagnoses for Mental and behavioural disorders and to procedure chapters which include counselling and generalised allied health interventions. These may also be treated as either admitted or non-admitted patient episodes, depending on admission practices.

Given the differences identified between the NHMD and the PHEC in the number of separations reported over this period and the fact that the ABS has ceased collection of data through the PHEC, the following steps have been identified as ways to improve national reporting of private hospitals information:

  • continue working with state and territory health authorities to improve coverage of reporting of admitted patient care activity
  • investigate the options for the AIHW to collect additional private hospital information to augment that currently collected for public hospitals. This could include information on hospital resources to address gaps left by the cessation of the PHEC, as well as information on non-admitted patient activity
  • Investigate whether linkage between the NHMD and other data sources, such as Medicare Benefits Schedule (MBS) data and Private Hospital Data Bureau (PHDB) data, can be used to identify and investigate private hospital activity which is not included in the NHMD
  • review the metadata for collecting hospital-sector data to develop well-defined and more consistent classifications for hospitals that are privately owned and/or operated but which undertake predominantly public activity.