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Publications |
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Topics in this section Private Patients' Hospital Charter Insure? Not Sure? (pdf format) Operations Of The Private Health Insurers Annual Report Financial and Statistical tables of past Operations Annual Reports |
PublicationsOperations Of The Private Health Insurers Annual Report 2006-07Part BOperations ReviewUtilisationThe utilisation of private health insurance in Australia has historically been in the areas of in-hospital services and ancillary services such as dental and optical. On 1 April 2007, as part of initiatives under the Private Health Insurance Act 2007, hospital-substitute treatment and chronic disease management programs were introduced. Benefits were paid for these two new categories in the June quarter of 2007. PHIAC will continue to monitor these areas of utilisation and will review their impact in the 2007–08 annual report. There is insufficient data to report the impact of hospital-substitute treatment and chronic disease management programs for 2006–07. Hospital treatment, servicesUtilisation of hospital treatment services is a major factor driving benefits paid by insurers. In this section hospital-substitute treatment services are included as hospital treatment services. During 2006–07, there were 7.356 million days in hospital, in 2.661 million hospital episodes of care, paid for by insurers. The number of days increased 4.5% and episodes increased 7.4% compared with 2005–06. Length of stay for acute episodes decreased 2.7% to an average of 2.8 days per episode, continuing a trend towards shorter length of stay. During these in-hospital episodes, 20.217 million medical services and 1.219 million prosthetic devices were paid for—increases of 4.2% and 6.0% respectively. Hospital utilisation is distributed over three categories of hospital: public, private and day-only facilities. During 2006–07, there were 369,094 episodes in public hospitals, 1.928 million episodes in private hospitals and 359,812 episodes in day hospital facilities. Also in 2006–07, episodes in:
In the new treatment category of hospital-substitute there were 4,560 episodes in the June quarter 2007. Day-only episodes in the three categories of hospital were 1.612 million—an increase of 7.9% compared with 2005–06—continuing the growth in day-only episodes of previous years. Hospital treatment, episodes by ageThe utilisation of services is affected by the demographic profile of the insured population. The most recognisable trend in utilisation by age cohort is the increase in hospital episodes per person as age increases. Utilisation by gender continues to record greater episodes for females during the child-bearing years, peaking at 30 to 34 years and at age 40 returning to resemble the male trend. From age 65, episodes per male covered are significantly higher than episodes per female covered. Figure 4 shows the distribution of hospital episodes per 1,000 persons covered by age cohort and gender over the 2006–07 year. This figure demonstrates the impact of demographic profile on utilisation. Figure 4. Hospital episodes per 1,000 persons covered by age cohort
The distribution of insured persons by age has an impact on claiming patterns. The trend in the average age of persons with hospital insurance shows a gradual change. The average age of insured persons as at 30 June 2007 was 39.9, an increase from the previous year of 0.1 years. This illustrates the changing average age of the insured population, which has implications for claiming rates. There has been an historical gradual ageing of the insured population(4) . From September 2001 to June 2007, the average age of persons covered has trended steadily upward. (4) The Australian population is also ageing. The average age of the overall population is less than that of the insured population, but the rate of increase in the average age is similar. Hospital treatment, days per insured personHospital days per insured person (figure 5) are relatively constant at younger ages, with an increase for females during child-bearing years. Consistent with the trend in benefits paid by age cohort, there is a strong trend upward in days per person as older ages are reached. Figure 5. Hospital treatment days per 1,000 insured persons
Length of stay (hospital days)For all age categories, the length of stay (figure 6) for females is greater than the length of stay for males, although there is minimal difference between genders for the ages 0 to 15 years and 45 to 74 years. Males in the older ages have more episodes but shorter length of stay. Length of stay trends upward for older persons, increasing dramatically from age 75. During the child-bearing ages the length of stay for females is significantly higher than it is for males. Figure 6. Length of stay (hospital days), by age cohort
Hospital days, by hospital typePublic and privateDuring 2006–07, there was a total of 7.356 million hospital days, an increase of 4.5% on 2005–06. There was an increase in public hospital days of 7.1%, increasing to 1.641 million days. Insured days in public hospitals includes day-only and overnight stays where insured persons choose to be treated as private patients. The increase in private hospital days was 3.4%, increasing to 5.349 million days. Days in private day hospital facilities increased 8.6%, to reach 360,652 days. Private hospital days are the largest category with 72.7% of days. Public hospitals have 22.3% and private day hospital facilities have 4.9% of days. Day–onlyBenefits are paid for day-only stays in public hospitals, private hospitals and day hospital facilities. During 2006–07, there was an increase in total day-only stays of 7.9%, or 117,415 days, to a total of 1.612 million days for the year. This follows an increase in total day-only stays in 2004–05 of 6.1% and in 2005–06 of 6.6%. Day-only utilisation grew in all public, private and day hospital facilities. There were increases in day-only stays of 11.3% in public hospitals to 159,558, and 6.7% in private hospitals to 1.087 million. Day-only stays in day hospital facilities increased 8.6% to 360,652. In the new category of hospital-substitute there were 4,533 days in the June 2007 quarter. Of all day-only stays, private hospitals were utilised for 67.4%, public hospital treatments for 9.9% and day hospital facilities for 22.4%. Hospital-substituteUtilisation of hospital-substitute treatment services in the June quarter of 2007 was similar to the pattern of hospital treatment services over the year. Episodes for females were mostly higher than episodes for males, especially in the child-bearing years. The number of episodes for females was relatively high in the child-bearing years and episodes were high in the older ages. Due to the limited data currently available on hospital-substitute treatment, the impact of utilisation of these services on the cost of benefits is unknown. PHIAC will review the impact in its 2007–08 annual report. Figure 7. Hospital-substitute episodes, by age cohort
Chronic disease management programsUtilisation of chronic disease management programs (CDMP) in the June quarter 2007 was dissimilar to the pattern of hospital treatment services over the year. Programs for females were mostly lower than episodes for males in contrast to the generally higher hospital episodes for females. CDMP were utilised more in older age groups up to age 79. Due to the limited data currently available on CDMP, the impact of utilisation of these services on the cost of benefits is unknown. PHIAC will review the impact in its 2007–08 annual report. Figure 8. Programs, by age cohort
General treatmentUtilisation of those general treatment services formerly categorised as ancillary services increased only marginally during 2006–07, preceded by a similar small increase in 2005–06.
These general treatment service categories together account for 80.3% of the cost of general treatment services excluding hospital-substitute and chronic disease management programs.
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