PHI 41/20 Release of 2018–19 Hospital Casemix Protocol and Private Hospital Data Bureau annual reports

Private health insurance announcement.

Date published:
Type:
PHI circular
PHI circular type:
PHI announcement
Audience:
Health sector

Hospital Casemix Protocol annual report

The Hospital Casemix Protocol (HCP) 2018–19 annual report has been re-released on the Department of Health website.  A preliminary version was released in January 2020 using data extracted in December 2019. The updated version uses data extracted in May 2020. For the majority of tables, statistics are presented for the time period 2010–11 to 2018–19.

The reports are available in Excel format and contain summarised data collected from private health insurers through HCP1.

Tables include statistics related to care type, completeness, charge components, patient age groups, medical services and Australian refined – diagnosis related groups (AR-DRG) (available for 2018–19 only) for privately insured separations in public and private hospitals.

The 2018-19 HCP annual report is available to download.

Private Hospital Data Bureau annual report

The Private Hospital Data Bureau (PHDB) 2018–19 annual report has been re-released on the Department of Health website. A preliminary version was released in January 2020 using data extracted in December 2019. The updated version uses data extracted in May 2020. For the majority of tables, statistics are presented for the time period 2010–11 to 2018–19.

The reports are available in Excel format and contain summarised data collected from private hospitals through PHDB.

Tables include statistics related to care type, completeness, charge components, funding source, patient age groups and Australian refined – diagnosis related groups (available for 2018–19 only) for private hospital separations.

The 2018-19 PHDB annual report is available to download.

To enable greater consistency between HCP and PHDB annual report statistics and figures published in the Australian Institute of Health and Welfare’s (AIHW) Australian hospital statistics annual reports, the hospital type (that is, public or private) has been adjusted in a small number of cases.

Further information is available in each annual report’s explanatory notes section.

Minor adjustments to the methodology used to calculate statistics presented in the HCP and PHDB annual reports may result in differences when compared with previously published annual reports.

The department notes there is an issue in the HCP (hospital to insurer), HCP1 (insurer to department) and PHDB data involving the supply of non-admitted service data such as those involving patients receiving services as outpatients, or visited by community nurses at home. In particular, these relate to the AR-DRGs (version 8.0):

  • U60A (Mental Health Treatment W/O ECT, Sameday, Major Complexity)
  • U60B (Mental Health Treatment W/O ECT, Sameday, Minor Complexity)
  • V65Z (Treatment for Alcohol Disorders, Sameday)
  • Z63A (Other Follow Up After Surgery or Medical Care, Major Complexity)
  • Z63B (Other Follow Up After Surgery or Medical Care, Minor Complexity).

Note: other AR-DRGs are also affected by this problem.

As outlined in the relevant data specifications, HCP, HCP1 and PHDB data should only contain admitted patient care episodes. Unfortunately, a relatively small number of these additional non-admitted records are currently included in both the HCP and PHDB annual reports, as there is insufficient information available to enable the department to exclude them. 

The department will consult with hospitals, health insurers and software vendors to ensure future data submissions are consistent with the scope of each data collection and contain admitted episodes only.

The department also notes the:

  • under-reporting of dialysis related separations in HCP1 and PHDB which primarily impacts AR-DRGs (version 8.0): L61Z (Haemodialysis) and L67C (Other Kidney and Urinary Tract Disorders, Minor Complexity)
  • over-reporting of rehabilitation separations in HCP1 which primarily impacts AR-DRG (version 8.0): Z60B Rehabilitation, Minor Complexity.

Any queries regarding these matters should be emailed to casemix.queries@health.gov.au.