Health services use by ex-serving Australian Defence Force members
Health services use by ex-serving Australian Defence Force (ADF) members is a series of reports that analyse the use of health services by ex-serving ADF members to 30 June 2020 to add to a picture of health service use and the factors associated with variations in health service use.
The research is presented across four reports, each with a specific focus:
- Health service use in the year before death by suicide among ex-serving ADF members.
- Health service use in the year before and after intentional self-harm among ex-serving ADF members.
- Health service use among ex-serving ADF members.
- Chronic conditions among ex-serving ADF members.
This research builds on previous analysis released by AIHW:
- Final report to the Independent Review of Past Defence and Veteran Suicides (2021).
- Characteristics of ex-serving Australian Defence Force members hospitalised for suicidality and intentional self-harm (2024).
The 4 reports provide insight into the health service needs of ex-serving Australian Defence Force (ADF) members through the linked dataset, the AIHW Veteran Health Dataset (VHD). The VHD allows the service use patterns for (de-identified) individuals to be tracked over time.
The VHD is a result of the AIHW partnering with the Department of Defence and Department of Veterans’ Affairs (DVA) to build a comprehensive profile of the health and welfare of Australia’s veteran population. For more information on the strategic partnership that was established in 2017, see Veterans AIHW-DVA strategic partnership.
The publication of these reports follows the release of the Final Report of the Royal Commission into Defence and Veteran Suicide and Government response to the Final Report. Importantly it builds the evidence base on the physical and mental health of ex-serving ADF members and will support the implementation of the Australian Government’s response.
The scope of the research was all ex-serving ADF members with at least 1 day of service since 1 January 1985. Their health service use was analysed over the period to June 2020.
There was a focus on ex-serving members who have accessed health services across:
- some primary care through the Medicare Benefit Schedule (MBS)
- public hospitals (admitted care and emergency department)
- Pharmaceutical Benefits Schedule (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS)
- DVA-funded public hospital and primary care during the study period.
Data sources
The VHD links national health system datasets with information on Defence personnel held by the Department of Defence and DVA client information held by DVA. The health system datasets provide information on interactions with hospitals, MBS and PBS/RPBS. The health system data also provides information on deaths, including deaths by suicide. The Defence and DVA data are linked to the health system datasets to identify ex-serving members and provide information on relevant characteristics.
Veteran Health Dataset
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Defence personnel data
Payroll systems data
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DVA client data
Eligible persons for DVA support
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DVA National Treatment Account
DVA funded health services
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Medicare consumer directory
Linkage identifier for persons who have Medicare
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Emergency departments
National Non-Admitted Patient Emergency Department Care Database
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Hospital admissions
National Hospital Morbidity Database
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Medicare Benefits Schedule
Primary health care services such as general practitioners, allied health or diagnostics
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Medications dispensed
- Pharmaceutical Benefits Scheme
- Repatriation Pharmaceutical Benefits Scheme
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Deaths
- National Mortality Database
- National Deaths Index
In addition to the VHD, the report on Chronic conditions among ex-serving ADF members uses the National Health Data Hub (NHDH) to enable comparisons between ex-serving members and the whole of Australia population. The NHDH (formerly known as the National Integrated Health Services Information Analysis Asset) is an enduring linked data asset managed under the custodianship of the AIHW. This analysis was based on an older version of the asset that only had data up to June 2020 so that it aligned with the VHD. The asset includes state and territory hospitals data and national health administrative data sets.
The VHD uses data from Defence personnel systems to identify current and ex-serving ADF members. Data is sourced from DVA to understand DVA client and DVA funded services. Together this information is linked to national health data to provide insights on the health service use of these persons. For this research, analysis was focused on ex-serving members only.
The Department of Defence personnel data consists of an extract from current and historical personnel systems for ADF members who have served since 1 January 1985. This combines Personnel Management Key Solution (PMKeyS), Core HR system, D1, CENRESPAY (for reservists), ADFPAY (for permanent members) and other historical payment systems. Validation of the data extract was performed with other data sources.
As well as identifying people who have served, the data also includes information on service characteristics. For ex-serving ADF members, service characteristics are reported as at date of separation from the ADF.
The DVA client data was used to identify ex-serving ADF members who were eligible for DVA-funded financial and/or healthcare support, from 1 July 2010 to 30 June 2020. This data is not limited to those who have used DVA services. There have been significant changes to DVA policy over the study period, particularly in increasing access to non-liability mental health care (care unrelated to ADF service). Since July 2017, all current and ex-serving ADF members have been entitled to non-liability health care for all mental health conditions and are considered DVA clients from first use of these services.
The National Treatment Account is an administrative data set containing records of DVA-funded health services provided to eligible DVA clients. This includes data for admitted patient care provided in public and private hospitals and for non-admitted emergency department care from 1 July 2010 to 30 June 2020. This also includes other DVA-funded health services such as primary health care and diagnostic tests.
The Medicare Consumer Directory (MCD) contains all people with a Medicare enrolment. The Department of Health, Disability and Ageing and Services Australia are joint data custodians for the MCD. The MCD is used as a linkage dataset, similar to how it is used in the Person Level Integrated Data Asset.
The National Non-Admitted Patient Emergency Department Care Database (NNAPEDCD) is a compilation of episode-level records for non-admitted patients registered for care in emergency departments (EDs) in selected public hospitals. It provides information on care, including waiting times, in public hospital EDs with designated assessment, treatment, and resuscitation areas, 24/7 medical and nursing staff, and a designated emergency nursing unit manager. The data quality statement and detailed data specifications for the NNAPEDCD are available online at Hospitals and National hospitals data collection.
The ED data was available for all states and territories except for Western Australia and the Northern Territory.
The National Hospital Morbidity Database (NHMD) is a compilation of records from the admitted patient morbidity data collection systems in Australian hospitals. It is a comprehensive data set that has records for all episodes of admitted patient care from public and private hospitals in Australia. The data supplied are based on the National Minimum Data Set (NMDS) for admitted patient care and include administrative, demographic, length of stay and clinical data including diagnoses, procedures and external causes of injury or poisoning. States and territories are primarily responsible for the quality of data and the AIHW also undertakes extensive validation procedures when it receives the data. For more information see National Hospital Morbidity Database.
The hospital data was available for all states and territories except for Western Australia and the Northern Territory.
The Medicare Benefits Schedule (MBS) data collection contains information on services that qualify for a benefit under the Health Insurance Act 1973 and for which a claim has been processed. The database comprises information about MBS claims (including benefits paid), patients and service providers. The administrative dataset is managed by the Department of Health, Disability and Ageing.
MBS does not include services provided under the DVA National Treatment Account or covered by third party or workers’ compensation.
For more information see Medicare Benefits Schedule data collection.
The Pharmaceutical Benefits Scheme (PBS) data collection contains information on prescription medicines that qualify for a benefit under the National Health Act 1953 and for which a claim has been processed. The database comprises information about PBS scripts and payments, patients, prescribers and dispensing pharmacies.
The administrative dataset is managed by the Department of Health, Disability and Ageing.
For more information see Pharmaceutical Benefits Scheme data collection.
The Repatriation Pharmaceutical Benefits Scheme (RPBS) and can be used by veterans who have DVA White, Gold or Orange Cards and is subsidised by DVA. The data collection contains information on prescription medicines that qualify for a benefit under the Veterans' Entitlements Act 1986 (Cwlth) and for which a claim has been processed. The database comprises information about RPBS scripts and payments, patients, prescribers and dispensing pharmacies.
The RPBS subsidises pharmaceuticals available under the Pharmaceutical Benefits Scheme and additional medicines and items (for example, wound dressings) for eligible people.
The National Mortality Database (NMD) holds records for deaths in Australia. The database comprises information about causes of death and other characteristics of the person, such as sex, age at death and area of usual residence. Cause of death and demographic items are coded by the Australian Bureau of Statistics from data originating from the Registrars of Births, Deaths and Marriages in each state and territory and the National Coronial Information System. The data are maintained by AIHW in the NMD.
The National Death Index (NDI) is managed by the AIHW and contains person-level records of all deaths in Australia obtained from the Registrars of Births, Deaths and Marriage in each state and territory. NDI use is confined to data linkage studies approved by the AIHW Ethics Committee for health and medical research. NDI records are supplemented with cause of death information from the National Mortality Database.
The data quality statement for the NDI are on the METEOR website.
The National Health Data Hub (NHDH) was used for analysis of the total Australian population as a comparator for the ex-serving ADF member population. The analysis was based on an older version of the asset that only had data up to June 2020 to align with the VHD (see National Integrated Health Service Information version 2.0). The asset includes state/territory hospitals data and national health administrative data sets.
The hospital data includes:
- admitted patient care services public hospitals data for all states and territories except WA and NT
- emergency department services public hospitals data for all states and territories except WA and NT
The national health administrative data includes:
- Medicare Benefits Schedule data
- Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data
- Residential Aged Care Services data (not used for this research)
- National Death Index.
More information is available at National Integrated Health Service Information (NIHSI) version 2.0 data quality statement.