National mental health report 2013

Private hospital care

Page last updated: 2013

Private psychiatric hospitals have focused primarily on the provision of inpatient care. This reflects both the history of mental health services in Australia and the predominant way in which health insurance funds have paid benefits for mental health care. More recently, innovative community models of service delivery are being established that either substitute for or complement inpatient care. The datasets used for the National Mental Health Report do not currently contain accurate data on these, so, apart from acknowledging the emergence of these new services, little other information can be provided.

This section summarises information compiled by the Australian Bureau of Statistics (ABS) over key years in the National Mental Health Strategy, using data from its Private Health Establishments collection (PHEC). The ABS did not conduct a private hospital survey in 2007‑08, the final year of the Third National Mental Health Plan. It also draws on an alternative source of private hospital data, auspiced by the Private Mental Health Alliance (PMHA) to supplement the information compiled from the ABS collection.30

Table 6 describes the activity in private hospitals from 1992‑93 to 2010‑11. The number of private hospitals reporting a specialist psychiatric unit has increased steadily over the course of the Strategy. Forty nine private hospitals providing psychiatric services in 2010‑11 reported to the ABS PHEC compared with 33 in 1992‑93.E

There has been growth in the number of psychiatric beds in private hospitals over time. In 1992‑93 there were 1,260 beds and in 2010‑11 there were 1,768, an increase of 40%. In per capita terms, these figures equate to 7.2 beds per 100,000 in the former year and 7.9 per 100,000 in the latter.

The number of patient days spent in private psychiatric units has also increased. In 1992‑93, 328,100 patient days were recorded. In 2010‑11, this figure had risen by 61% to 676,654. In population terms, these figures translate to 19 patient days per 100,000 in 1992‑93 and 30 patient days per 100,000 in 2010‑11.

Staffing of private hospital psychiatric units has increased alongside bed numbers and patient days. In the baseline year, there were 1,222 full‑time equivalent staff working in psychiatric units in private hospitals Australia‑wide (seven per 100,000). By 2010‑11, there were 2,290 (10 per 100,000). This represents an increase of 87% in absolute terms.

About one third of the growth (31%) in patient days in private psychiatric hospitals was accounted for by a substantial rise in same‑day admissions, which increased nearly twelve fold between 1992‑93 and 2010‑11. Same‑day admissions accounted for 78% of all discharges from private psychiatric hospital units in 2010‑11 and represent the most frequent type of service provided. Same‑day admissions across the broader private hospital sector have also increased significantly, but at a much lesser rate than in the psychiatric units that form part of the sector. Total same‑day admissions increased approximately four fold in all private hospitals (including freestanding day facilities) between 1992‑93 and 2010‑11 and accounted for 64% of total separations in 2006‑07.

Same‑day care in the general health field refers to patients admitted to hospital for a medical, surgical or diagnostic procedure who are discharged on the day of admission. In the mental health field, most same‑day admissions to private hospitals represent individual days of care that fall within planned episodes of ambulatory mental health care. In its Annual Statistical Report Series, the PMHA reported that Australia's private hospital psychiatric units delivered 13.335 episodes of ambulatory mental health care in 2010‑11, with an average of 11 days of care per episode.30 These episodes typically involve participation by consumers in structured, group‑based psychotherapeutic programs, run by allied health professionals or nurses with formal training in these forms of therapy. A relatively small proportion of same‑day admissions to psychiatric hospital units are for electroconvulsive therapy, most usually provided to consumers with recurrent severe major depression.

Activity data relating to private hospital psychiatric units are considered in the context of expenditure data in Figure 34. Estimated recurrent expenditure by private psychiatric units in 2010‑11 was $307 million, an increase of 142% since 1992‑93. This increase in expenditure outweighs the increases in beds, patient days and staffing, described above. Top of page

Table 6: Activity in private hospitals with psychiatric units, 1992-93 to 2010-11

1992-93
(Baseline year)
1997-98
(End of 1st plan)
2002-03
(End 2nd plan)
2007-08
(End 3rd plan)
2010-11
(Mid 4th plan)
Hospitals
33
39
46
n.a.
49
Beds
1,260
1,507
1,727
n.a.
1,768
Beds per 100,000
7.2
8.1
8.7
n.a.
7.9
Patient days
328,100
380,117
510,634
n.a.
676,654
Patient days per 100,000
18.7
20.4
25.8
m.a.
30.1
Staff (FTE)
1,222
1,697
2,143
n.a.
2,290
Staff (FTE) per 100,000
7.0
9.1
10.8
n.a.
10.2
Top of page

Figure 34: Selected indicators of change in the private psychiatric hospital sector, 1992-93 to 2010-11

Refer to the following table for a text equivalent of Figure 34: Selected indicators of change in the private psychiatric hospital sector, 1992-93 to 2010-11

Text version of figure 34

Expenditure (%)Staffing (%)Beds (%)Days (%)
1992-93 (Baseline year)
0
0
0
0
1993-94
13
14
10
5
1994-95
24
16
11
10
1995-96
27
17
9
14
1996-97
25
25
6
13
1997-98 (End 1st plan)
36
39
20
16
1998-99
61
61
30
30
1999-2000
56
55
28
29
2000-01
78
67
37
49
2001-02
89
80
38
59
2002-03 (End 2nd plan)
90
75
37
56
2003-04
85
60
31
56
2004-05
88
56
37
64
2005-06
93
65
37
68
2006-07
96
55
45
78
2007-08 (End 3rd plan)
104
na
na
na
2008-09
110
89
46
88
2009-10
126
101
43
97
2010-11 (Mid 4th plan)
142
87
40
106

Footnotes

E Data from the PMHA collection (see www.pmha.com.au) suggests that this may be a slight undercount. The PMHA's Annual Statistical Report suggests that there were 53 private hospitals with specialised psychiatric units operating in 2010‑11.