Data processing: Non-government funding sources
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The non-government total health spending includes spending:
- by PHI providers (column G)
- by Individuals (column H)
- by Other private entities (column I)
- by Workers’ compensation insurance providers (column J)
- by CTPI providers (column K)
Expenditure components
PHI providers help finance certain health goods and services. Health spending by PHI providers are the gross fund benefits paid to health providers and administration spending. Expenditure estimates are equal to gross health spending minus the PHI premium rebates (claimed through PHI providers and tax; processed in columns C and M, respectively).
APRA provides input data for these estimates, on a state and territory basis, from the following:
- PHI Membership and Benefits
- PHI Prosthesis Report
- Operations of Private Health Insurers Annual Report data.
Gross health spending by the PHI providers is mapped to the following areas of expenditure:
- Public hospitals (row 01)
- Private hospitals (row 04)
- Patient transport services (row 12)
- Referred medical services (row 14) (as discussed in subsection 2.3.4 and column D above, this is related to in-hospital MBS services where PHI shares the gap payment after the Australian Government benefit is paid)
- Dental services (row 15)
- Other health practitioners (row 16)
- Community health (row 20)
- All other medications (row 22)
- Aids and appliances (row 24)
The ambulance levy for NSW and ACT are assigned as Patient transport services (row 12). Because many NSW residents in areas close to the ACT can use the hospital services in ACT, the levy amount provided by APRA in ‘State levies’ is adjusted proportionally using ambulance levy figures from NSW Treasury and ACT Treasury.
Total administrative expenses are assigned to Hospital insurance administration (row 28).
Offsets
The Australian Government rebates for PHI premiums claimed through PHI providers and tax (columns C and M, respectively) are treated as subsidies to PHI providers, therefore these are deducted from gross expenditure by PHI providers.
Notes
The PHI provider gross health expenditure (including all subsidies) in rows 04, 14, 15, 16, 22, 24 is offset against Individuals (column H).
The spending amounts on Public hospitals (row 01) and Ambulance levy (row 12, for NSW and ACT) are offset against the relevant state and territory governments (column F).
Expenditure components
Individuals fund health goods and services through out-of-pocket costs. This includes co-payment for government-subsidised goods and services, co-payment for the cost of health goods and services with third party payers and meeting the full cost of goods and services (see subsection 2.2.2).
The data used in estimating these costs are sourced from:
- Private hospital patient revenue (row 04) from PHDB and ABS PHEC.
- Out-of-pocket contributions for health services for Referred medical services (row 14, including in-hospital and out-of-hospital MBS), Dental services (row 15), Other health practitioners (row 16) and Medical services (unreferred) (row 40) from MBS. The contribution by individuals is derived by subtracting the benefits paid from the fees charged.
- Individual contributions for medications covered by PBS Section 85 and RPBS (rows 21 and 22) from PBS and RPBS, respectively. For prescriptions that cost above the co-payment, individual contributions are assigned to Benefit-paid pharmaceuticals (row 21). For prescriptions which are priced below the co-payment, individual costs are assigned to All other medications (row 22).
- Data about payments for medications purchased in pharmacies and supermarkets (row 22) are obtained from IRI. State and territory level spending is derived using proportions obtained from historical ABS HFCE.
- Payments for prescriptions for which no benefit is payable are estimated using The Pharmacy Guild of Australia and historical data and allocated to All other medications (row 22).
- Expenditure on Dental services (row 15), Other health practitioners (row 16), Aids and appliances (row 24) is estimated using historical data and the growth rate of PHI fees charged and the growth of PHI member coverage obtained from APRA.
- revenue from individuals received by state and territory health organisations (in various rows (from 01 to 32) is from the GHE NMDS ‘Revenue’. More details on the allocation of revenue to areas of expenditure in GHE NMDS are described in the processing of column F (state and territory governments).
Offsets
- PHI gross expenditure (in rows 04, 14, 15, 16, 22, 24) (processed in column G) is offset from the total gap payment (after the government benefits) in the relevant area of spending.
- Private hospital payments (row 04) by individuals that are funded by DVA (processed in column A) are offset as DVA subsidises costs to eligible veterans and families.
- Benefit payments by injury insurance providers (rows 04, 22, 24) are offset against individual costs (processed in columns J and K), as individuals are reimbursed these costs.
- Medical expenses tax rebate (row 37), which is from Treasury–Tax Benchmarks and Variations Statement (processed in column E) to account for reimbursement of individual costs through the taxation system. This item phased out after 2018–19, though a small amount appears in 2020–21 data (late claims and processing).
Notes
There are no further notes for column H.
Expenditure components
Workers’ compensation is a form of compulsory insurance payment to employees if they are injured at work or become sick due to their work (see subsection 2.2.3).
Data on health expenditure by workers’ compensation insurance providers are obtained from the workers’ compensation insurance regulatory authority in each state and territory (Box 2.3) and Comcare.
Data on benefits paid by Vic, SA, ACT, NT and Comcare are mapped to the following areas of expenditure:
- Public hospitals (row 01)
- Private hospitals (row 04)
- Patient transport services (row 12)
- Referred medical services (row 14)
- Dental services (row 15)
- Other health practitioners (row 16)
- Community health (row 20)
- All other medications (row 22)
- Aids and Appliances (row 24)
- Unreferred medical services (row 40).
Data on benefits paid are not provided for several health service categories for NSW, Qld, WA and Tas. For these states, data are apportioned based on benefits paid to each area of expenditure in Vic, SA and through Comcare.
For some jurisdictions, revenues from workers’ compensation insurance providers reported in GHE NMDS ‘Revenue’ are also included in workers’ compensation insurance expenditure (in rows from 01 to 32).
Offsets
There are no offsets for column J.
Notes
The amounts funded by workers’ compensation insurance for Private hospitals (row 04), All other medication (row 22), Aids and Appliances (row 24) are offset against Individuals (column H) in the respective areas of expenditure.
The amounts of Public hospitals (row 01) funded by Workers’ compensation insurance are offset against State and territory governments (column F) for some jurisdictions.
Expenditure components
CTPI provides compensation for anyone injured or killed in a motor vehicle accident (see subsection 2.2.4).
Data on expenditure by CTPI providers are obtained from the CTPI regulatory authority in each state and territory (Box 2.4). Each agency collects different data, with the most comprehensive information on CTPI benefits paid provided by the Transport Accident Commission (Vic) and the Motor Accident Commission (SA).
For Vic and SA, CTPI benefit expenditure are mapped with the following areas of expenditure:
- Public hospitals (row 01)
- Private hospitals (row 04)
- Patient transport services (row 12)
- Referred medical services (row 14)
- Dental services (row 15)
- Other health practitioners (row 16)
- Community health (row 20)
- All other medications (row 22)
- Aids and Appliances (row 24)
- Unreferred medical services (row 40).
The proportion of benefits paid in each area of health spending in Vic are used to allocate expenditure for each health area in NSW, Qld, WA and Tas. Population proportions are used to estimate CTPI provider health spending for ACT.
For some jurisdictions, revenues from CTPI providers reported in GHE NMDS ‘Revenue’ are also included in CTPI expenditure (in rows 01, 06, 12, 15, 20, 27, 30, 32).
Offsets
There are no offsets for column K.
Notes
The amounts funded by CTPI for Private hospitals (row 04), All other medications (row 22) and Aids and Appliances (row 24) are offset against Individuals (column H) in the respective area of expenditure.
The amounts for Public hospitals (row 01) funded by CTPI are offset against State and territory governments (column F) for some jurisdictions.
Expenditure components
Other private expenditure is part of non-government funding of health goods and services (see subsection 2.2.5).
The data used for estimating spending are sourced from:
- Non-patient revenue of private hospitals (row 04) estimated from ABS PHEC and PHDB
- Capital expenditure from ABS Private GFCF (row 36)
- Expenditure funded by private non-profit organisations on health research (rows 31 and 32): data from ABS Research and Experimental Development statistics
- Revenue that state and territory health organisations received from other private sources (in various rows from 01 to 32): data from GHE NMDS ‘Revenue’.
Offsets
There are no offsets for column I.
Notes
There are no further notes for column I.
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Data source |
Notes |
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ABS Australian National Accounts: National Income, Expenditure and Product
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These data provide information about capital expenditure (as outlined in Australian System of National Accounts (5204.0)) by:
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ABS Government Finance Statistics, Australia
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Prior to 2015, the Economic type framework 1231: depreciation of fixed assets (non-defence), which refers to amounts charged to current operations in respect of the consumption of non-current tangible assets not related to defence weapons platforms was based on the Government Finance Statistics framework outlined in 2005 (ABS Australian system of Government Finance Statistics; 5514.0). As of 2015, this category was revised to Economic type framework 1241. However, the ABS Government Finance Statistics publications and associated output continued to be published on the previous Government Finance Statistics framework as outlined in Australian System of Government Finance Statistics: Concepts Sources & Methods, Australia 2005 until September quarter 2017. |
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ABS Australian National Accounts: National Income, Expenditure and Product
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ABS Research and Experimental Development statistics
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Data on expenditure and human resources devoted to research and development (R&D) carried out by higher education organisations, government and private non-profit organisations in Australia. Data classification used is based on the socio-economic objective of the research as health. Data are collected biannually. Most recent surveys:
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ABS PHEC (Private Health Establishments Collection) |
The Private Health Establishments collection was an annual survey which collected information about the activities, staffing and finances of all private hospitals (private acute and psychiatric hospitals, and free-standing day hospital facilities). The results of the final survey were published in Private Hospitals, Australia, 2016–17. The ABS PHEC provided estimates of individual and other private spending on private hospitals. In 2017–18 these estimates were modelled from the final 2016–17 collection. However, as of 2018–19, individual spending was obtained from the Private Hospitals Data Bureau, while other private spending continued to be modelled on the final PHEC survey data. |
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Australian Department of Defence |
Unpublished data request, provided by the Joint Health Command (since 2019–20) |
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APRA (Australian Prudential Regulation Authority) data
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These data provide information about PHI, with most data provided on a quarterly basis at the state and territory level. |
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ATO (Australian Taxation Office) annual report |
Data related to the PHI premium rebates claimed through tax. This information is published annually by the ATO. |
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Comcare |
Data request, provided by Comcare |
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CTPI data
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Data request, provided by jurisdictions’ CTPI regulators |
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DHAC (Department of Health and Aged Care)
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Data provided by DHAC annually |
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DVA (Department of Veterans’ Affairs) MRCA and SRCA |
Data request, provided by DVA |
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DVA (Department of Veterans’ Affairs) NTA (National Treatment Account) program benefits |
Data request, provided by DVA |
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GHE NMDS (Government Health Expenditure National Minimum Data Set)
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The GHE NMDS collects information about the direct government and government-funded expenditure on health and health-related goods and services. The most recent NMDS was implemented from 2014. More information on the GHE NMDS can be found in AIHW METEOR. |
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MBS (Medical Benefits Schedule) |
Data held at DHAC, accessed by AIHW |
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NHMRC (National Health and Medical Research Council) grants |
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NHFB (National Health Funding Body) |
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PBS (Pharmaceutical Benefits Scheme)
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Data held at DHAC, accessed by AIHW |
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PHDB (Private Hospitals Data Bureau) |
Since 2018–19, these data were used to estimate of patient revenue in private hospitals. Prior to this ABS PHEC data provided this estimate. |
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RPBS (Repatriation Pharmaceutical Benefits Scheme) |
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The Treasury
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Table 36 of the Treasury Final Budget Outcome provides the expenditure of the Australian Government on NHR funding and NPPs to the states and territories. This information is published annually. Net medical expenses tax rebate is included in the Tax Benchmarks and Variation Statement. |
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Workers’ compensation data
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Note: Information regarding the data sources of deflators used for analysis presented in the HEA are not included in this table (see Deflators and Box 2.6)