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Hospital Performance: Costs of acute admitted patients in public hospitals from 2012–13 to 2014–15

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About the data

The Australian Institute of Health and Welfare (AIHW) worked with the Independent Hospital Pricing Authority (IHPA) on the development of the report. Data outputs used for the report were prepared by the IHPA using specifications that were developed between the two agencies. The data sources for this report include the:

  • National Hospital Cost Data Collection (NHCDC)
  • Admitted Patient Care National Minimum Data Set (APC NMDS)
  • Hospital Casemix Protocol (HCP) data collection.

National Hospital Cost Data Collection

The NHCDC is a voluntary collection of public hospital costs, established in 1996–97 (IHPA 2016). Hospitals calculate the cost of a patient’s episode using a set of standards called the Australian Hospital Patient Costing Standards (AHPCS). During the three year span covered by the report two versions of the costing standards were used, version 2.0.1 (DoHA 2011) (2012–13) and version 3.1 (IHPA 2014) (2013–14 and 2014–15).

Version 3.1 of the AHPCS contained four new standards relating to the:

  • distribution of clinical salary and wages
  • allocation of medical costs for private and public patients
  • intermediate product/service matching method
  • interpretation of product costs data.

These new standards were introduced to improve the validity and completeness of the NHCDC.

For more information about the NHCDC and the AHPCS can be found at https://www.ihpa.gov.au/what-we-do/NHCDC.

Admitted Patient Care National Minimum Data Set

The APC NMDS is a data set specification for episode-level records from admitted patients in Australian hospitals. It includes demographic, administrative, length of stay and the patient’s conditions and procedure specifications for each hospital separation.

A separation refers to an 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 due to a change of type of care (for example from acute care to rehabilitation). The counting unit for the APC NMDS is the separation but is often referred to as an admission. For the purposes of the report, and on the MyHospitals website, an episode of admitted patient care is referred to as an ‘admission’, which is synonymous with a ‘separation’.

Admissions are grouped according to the complexity of conditions and procedures, and individual patient characteristics, using the AR–DRG version 8.0 (v8.0) (IHPA 2018).

For more information about the APC NMDS see the AIHW specification at: http://meteor.aihw.gov.au/content/index.phtml/itemId/535047

Hospital Casemix Protocol

The Hospital Casemix Protocol (HCP) data set collects episodic financial data for privately insured admitted patients (DoH 2017).

As the costs of private patients are not publicly funded and are not fully recorded by the NHCDC in some jurisdictions, the IHPA sources extra data from the HCP data set to better estimate the complete costs of private patients. This adjustment is undertaken by the IHPA for the National Efficient Price (NEP) Determination. The HCP data set, managed by the Australian Government Department of Health, collects data directly from all private health insurance providers and covers all privately insured admitted patients. See Table 2 for more information on costs included.

Hospital results included in the report

To ensure robust comparable results and protect the privacy of patients, a hospital was reported in a specific financial year if it met the following criteria:

  • The hospital was a non-specialist major, large or medium public hospital where costing and activity data were available for at least two consecutive financial years. (Note: emergency department costs are not included.)
  1. More than or equal to 90 per cent of APC NMDS patient unit records were matched to the NHCDC unit records, of total acute admitted patient care unit records at the hospital.
  2. No anomalies were identified following triangulation analysis of cost data between the NHCDC and the National Public Hospital Establishments Database (NPHED).
  3. Greater than zero Intensive Care Unit (ICU) hours were reported where a hospital had an ICU eligible for an NWAU ICU adjustment. (Note results for 8 hospitals were suppressed in 2012–13 as they did not meet this criterion.)

For each financial year, the number of public hospitals with an emergency department that were eligible, excluded and those with results published in the report or on the MyHospitals website are outlined in Table 1.

Table 1: Hospitals with published results

2012–13 2013–14 2014–15
Eligible public hospitals with an emergency department 129 130 130
Excluded public hospitals with an emergency department 19 13 11
Hospital result published in report or on MyHospitals website 112 119 121

Data supply

Data outputs used in this report were supplied by the IHPA on 26 September 2017. Individual states and territories have not revised the data supplied to the IHPA since this date. The AIHW acknowledges that data provided by states and territories may be updated with various Australian Government agencies as improvements are made in their collections.