Table 2
Trends and hospital admissions
Years ended March 2005 – 2009

Table 3
Top ten overnight surgical and obstetrics admissions
Years ended March 2007–2009

Table 4
Top ten overnight medical, psychiatry and rehabilitation admissions
Years ended March 2007–2009

Source: HCF Hospital claims data
Note: The column “Category” indicates whether the reason for admission is medical (M), psychiatry (P) or rehabilitation (R).

Table 4
The 10 most common procedures for medical, psychiatry and rehabilitation care accounted for 53.2 per cent of all admissions. There were five conditions common to both the public and private sectors – Observation and follow-up, Digestive system disorders, Chest pain, Lung infections, and Sick neonates.

Overall, public hospital admissions increased by 7.9 per cent with the main increases being admissions for Other heart disorders (27.9 per cent), Sick neonates (22.1 per cent), Bronchitis and asthma (20.2 per cent) and Lung infections (12.6 per cent).

In private hospitals, overall admissions in these patient categories increased by 4.8 per cent. The most notable increases were in Orthopaedic rehabilitation (32.7 per cent), Alcoholism/drug dependence/overdose (28.1 per cent), Other renal diseases (22.5 per cent) and Major depressive episode (21.3 per cent).

Table 5
Top ten day only admissions (all categories)
Years ended March 2007–2009

Source: HCF Hospital claims data
Note: The column “Category” indicates whether the reason for admission is medical (M), psychiatric (P), rehabilitation (R), obstetric (O) or surgical (S).

Table 5
Same day hospital admissions in both public and private hospitals and day facilities accounted for 63.2 per cent of all hospital admissions, increasing by less than 1 per cent compared with last year (62.8 per cent).

Public hospital same day admissions increased by 4.6 per cent with increases evident in six of the categories listed in the ‘Top 10 day only admissions’ compared with last year. The main increases were in Cellulitis (62 per cent), Chemotherapy (19.5 per cent), Skin tumour removal (14.1 per cent), and Chest pain (10.2 per cent).

Same day admissions in private hospitals increased by 9.7 per cent with increases in all of the categories listed.

Table 6
Selected high cost private hospital admission types, by average charge per admission
Years ended March 2008–2009

Source: HCF Hospital claims data; HCF Current membership data
Note: The Maximum charge in the total rows of the above table is the highest of all the maximum charges listed.

Table 6
We have ranked high cost procedures on the basis of the average hospital charge per admission. Charges per admission depend on factors such as casemix and length of stay and the types of patients who underwent these treatments. The charges for medical admissions are primarily based on the cost of the length of stay in hospital. Surgical admissions usually also include charges for theatre, intensive care facilities, prostheses or disposable items in addition to length of stay.

The total charges for these 22 high cost procedures accounted for 19.2 per cent of total hospital charges in 2008/09, but only accounted for 2.6 per cent of all admissions.

The number of admissions for high cost medical procedures decreased by 12.9 per cent compared with the previous year. The overall decrease in the average length of stay has resulted in a decrease in the overall average charge for the high cost medical procedures listed. The number of admissions for high cost surgical procedures increased by 13.9 per cent on the previous year. The majority of surgical high volume, high cost admissions continue to be for cardiac and orthopaedic procedures. Heart valve replacement procedures had the highest average charge. The combined charge for the 22 highest cost procedures has increased by 16.6 per cent.

Table 7
Maternity
Years ended March 2005 – 2009

Table 7 and Table 8
Maternity admissions to public hospitals increased by 1.9 per cent while maternity admissions to private hospitals decreased by 0.6 per cent. The caesarian section rate continues to increase each year. For private hospital patients aged 35–49 the caesarean section rate for the year was 49.7 per cent (47.8 per cent last year). For women between the ages of 15–34 (usually considered a lower risk group) the caesarian rate in private hospitals has increased to 39.4 per cent (37.8 per cent last year). These figures should be viewed in context of many women choosing to have private health insurance because they know they will fall into a high-risk group, independent of age. There is also a debate that a high caesarian section rate can be appropriate, depending on the risk factors of mothers. Females aged between 15 and 49 experienced a birth ratio of 40 admissions per 1,000 female persons covered, 0.7 per cent higher than last year.

Table 8
Maternity admission trends

Source: HCF Hospital claims data; HCF Current membership data
Note: This table includes admissions for overnight and sameday confinements only (ie. no other obstetric treatment).

Table 7 and Table 8
Maternity admissions to public hospitals increased by 1.9 per cent while maternity admissions to private hospitals decreased by 0.6 per cent. The caesarian section rate continues to increase each year. For private hospital patients aged 35–49 the caesarean section rate for the year was 49.7 per cent (47.8 per cent last year). For women between the ages of 15–34 (usually considered a lower risk group) the caesarian rate in private hospitals has increased to 39.4 per cent (37.8 per cent last year). These figures should be viewed in context of many women choosing to have private health insurance because they know they will fall into a high-risk group, independent of age. There is also a debate that a high caesarian section rate can be appropriate, depending on the risk factors of mothers. Females aged between 15 and 49 experienced a birth ratio of 40 admissions per 1,000 female persons covered, 0.7 per cent higher than last year.

Table 9
Overnight psychiatric hospital admissions
Year ended March 2009

Source: HCF Hospital claims data; HCF Current membership data
Note:
Each patient may appear in more than one group. For example, 50 patients had admissions in both the public and private sector during the year ended March 2009.
Patients may also move between age groups between subsequent admissions.
Of the 1,691 patients, 496 had multiple psychiatric admissions during the year.
Some of these patients may have been re-admitted for same day as well as overnight stay.

Table 9
There was a substantial increase in both the number of overnight psychiatric patients and admissions compared with last year (7.3 per cent and 15.8 per cent respectively). Admissions to public hospitals decreased 5.0 per cent. The proportion of services delivered by the public sector is 10.9 per cent (13.3 per cent last year). Admissions to private hospitals increased by 19 per cent. Private hospital admissions for overnight psychiatric services accounted for 89 per cent of all overnight psychiatric hospital admissions.

On average, the number of admissions per patient increased to 1.5 (1.4 last year). The average length of stay was 17 days, a decrease of 8.1 per cent compared with last year. Approximately 27.9 per cent of patients were re-admitted to hospital within 35 days (24.5 per cent last year). The number of patients who required re-admission more than 35 days after discharge increased substantially from 17.6 per cent to 25.4 per cent. For private hospital admissions, females aged between 20 and 44 years continue to have the greatest requirement for hospital admission relating to a psychiatric condition.

Table 10
Summary of 200 highest cost claimants by category
Year ended March 2009

Source: HCF Hospital claims data; HCF Health policy data
Note: This table includes same day and overnight admissions. “Other” includes those categories which had 2 patients or less.
Admissions for renal dialysis have been excluded from the analysis as dialysis skews the admissions per patient indicator.

Table 10
The median patient age for highest cost claimants is 68 years with an average length of membership of 21 years.

Average benefits paid per patient decreased slightly by $194 from $105,356 last year to $105,162 this year (a decrease of 0.18 per cent). The average benefit paid is equivalent to 60 years’ membership as a single in HCF’s Top Plus hospital cover.

Categorisation is based on the highest cost procedure for a claimant and the total claimed. This means the specialty illness groups chosen can change significantly from year to year. Cardio thoracic surgery continues to be the highest cost specialty procedure particularly due to the prosthetic implants involved. This is followed by Rehabilitation and Orthopaedic surgery. General Surgical admissions had the highest average benefit paid for a procedure, at $124,724 per member.

Adverse events, defined as unintended injuries caused by medical management rather than the underlying condition of the patient, may have contributed to these high cost procedures. Examples of adverse events include hospital-acquired infections, medication errors, unintended admission to intensive care unit, unintended return to operating theatre, length of stay greater than 21 days and same prosthesis implanted within two years. An adverse event attributable to error is potentially preventable.

Table 11
2008/09 Medical charges statistics
Year ended March 2009

Table 11
For the year ended 31 March 2009, 2,084,359 in-hospital medical services were provided to HCF members, an increase of 162,462 (8.45%) services compared with the previous 12 month period. Doctors charged a total of $318 million for these services which represents an increase of $36 million (12.77%) compared with 2007/08.

The equivalent Medicare Benefits Schedule fee for these services was $200.3 million (63%) of the amount charged. Medicare refunded $149.7 million and HCF paid benefits of $104.9 million under its gap cover and other schemes. The balance, $63.7 million (20% of total medical charges) represents the patient out of pocket cost for medical services. Total medical benefits paid by HCF increased by $12.9 million (14%) over this period.

Table 11 provides a list of the most common in-hospital medical services covered by HCF. We have highlighted 15 procedures where the average charge is between $389 and $1,515 more than the Commonwealth Medicare Benefits Schedule fee (CMBS).