Our role in hospital care

Learn about funding and support for public and private hospitals in Australia, including how to become a declared hospital and data reporting requirements.

Funding for public hospitals

Through the National Health Reform Agreement, the Australian Government contributes funds to help states and territories deliver public hospital services.

The Independent Health and Aged Care Pricing Authority collects data on the cost of hospital services and works out a national efficient price (NEP) for each one. Learn more about their role in pricing public hospital services.

Hospitals submit data on the number of hospital services performed and the types of patients.

We combine this information to make sure payments to hospitals are fair and based on the:

  • number of hospital service they perform
  • NEP for each procedure, which includes consideration of the types of patients being treated – some are more complex to treat than others.

This is known as activity-based funding.

Find out more about how this funding is distributed on the National Health Funding Body website.

Support for private hospitals

We have a role in administering private health insurance, including:

Learn more about private health insurance.

Hospital declarations

Before a hospital can receive benefits from private health insurers, the Minister for Health and Aged Care must declare the facility or service to be a hospital.

Facilities or services must apply to be declared a hospital when:

  • they begin operating
  • merge with another hospital.

Private hospitals must also be licensed by their state or territory government.

Second-tier benefit eligibility

Private hospitals can apply to be eligible for second-tier benefits. This means that insurers must pay the hospital more than the minimum treatment benefit, even if they don’t have a negotiated agreement with the hospital.

Learn more about second-tier benefit eligibility.

Collecting hospital data

Both private and public hospitals provide data about medical procedures and patients, including:

They must submit this data through an online portal.

We provide standards for submitting this data.

We manage other hospital-related data collections that give us information about hospital activity, including:

  • hospital characteristics
  • non-admitted patient care
  • admitted patient care
  • elective surgery waiting times
  • emergency department waiting times.

Learn more about hospital data collections, including data managed by the Australian Institute of Health and Welfare.

Date last updated:

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