Introduction

The AIHW Disease expenditure database takes data from Australia’s National Health Accounts, that forms the base of reporting for the AIHW Health expenditure Australia report series (latest report, AIHW 2024a), and further examines the data to understand more about the people receiving care and the diseases and conditions being managed. The Disease expenditure database contains spending estimates for 17 Australian Burden of Disease Study (ABDS) groups and the 220 conditions within those groups, by age group and sex for each of the following broad and detailed areas of spending:

  • Hospitals
    • Public hospital admitted patients
    • Public hospital emergency departments
    • Public hospital outpatients
    • Private hospital services
  • Primary health care 
    • general practitioner services
    • allied health and other services
    • pharmaceutical benefits scheme
    • dental expenditure (not available by age group and sex)
  • Referred medical services
    • specialist services
    • pathology
    • medical imaging

Spending on health prevention (through public and community health programs) is currently not included as part of the AIHW Disease Expenditure database due to the difficulty in allocating this spending to specific burden of disease conditions. The scope of the disease expenditure database will however expand to include spending on cancer screening in future reports. The AIHW will consider if other spending on prevention can be included into the disease expenditure database as well.

While health research is also not included as part of the Disease Expenditure database, there is a separate section in this report that reflects on National Health and Medical Research Council (NHMRC) expenditure for disease, research and health areas presented according to the International Classification of Diseases (ICD).

In this report, spending for three additional groups (outside the 17 disease groups) have been included in this report – well care, the treatment of risk factors and examination and observation NEC. Well care includes the following seven sub-categories of spending:

  • well person (includes expenditure for services that are typically routine examinations, general examinations without specific complaints or diagnoses, or administrative in nature)
  • well dental (includes routine checkups and cleaning)
  • pregnancy and postpartum care
  • family planning
  • counselling services
  • social services (includes problems related to housing and economic circumstances, social environment, support groups)
  • donor

Estimates of spending on Coronavirus 19 (COVID–19) in the hospital setting as well as through the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS) and research, have been included in this report. For a more detailed analysis of the response to COVID–19, refer to Health system spending on the response to COVID–19 in Australia 2019–20 to 2022–23 (AIHW 2024b).  

The data in the AIHW Disease expenditure database and in this report includes all sources of funding, including patient co-payments. Spending estimates are based on hospital admissions, emergency department records, outpatient records, MBS and PBS records. For each of these data sources, patients' sex was recorded as male, female or other, not reported or unknown.

This may be based on what the patient selected, or how staff completed the record. It may also be based on an existing record for the patient, which may no longer reflect how they identify.

It is important to note that it is not known if the people completing these records interpreted sex to mean sex at birth or gender identity.

This report uses the terms 'male’ and ‘female', but it should be noted that some participants may not identify with these terms. Where sex was reported as other, not reported or unknown, the data has been included as part of the spending for ‘Total Persons’.

How do we measure disease costs?

The cost of disease is not just financial. Being unwell or suffering from a health condition has other effects on quality of life, affecting people’s ability to work or do the activities they enjoy. The spending estimates in this report do not include direct costs from outside of the health care sector or estimates of the indirect costs due to illness.

How much is spent on treating, managing, or preventing conditions in financial terms can be influenced by a range of factors such as the cost and availability of effective treatments, and disease prevalence. As such, the disease expenditure estimates in this report do not necessarily reflect the incidence or prevalence of those conditions, or the full ‘burden’, or human cost. Refer to the Comparison of disease expenditure and disease burden section in this report and AIHW 2023a for further information.

It is not feasible (or appropriate) to allocate some forms of health spending to specific diseases. For example, administration expenditure and capital expenditure are generally unable to be attributed to any particular condition. In addition, most community and public health programs, which support the treatment and prevention of many conditions, do not have sufficient data to allocate to conditions. Therefore, the disease expenditure estimates in this publication are not directly comparable with estimates published in the AIHW’s Health expenditure Australia reports (which cover all health spending) (AIHW 2024a). Refer to Figure 1 in this report and Table 2.2 in the accompanying methods paper for more detailed information on the inclusions and exclusions. For further details on the estimation methods, scope of data included, and comparability to previous studies, readers should refer to the accompanying methods report, Health system spending on disease and injury in Australia, 2022-23: Overview of analysis and methodology available from the Related material section of this report.

Health spending in Australia is generally managed through particular funding programs such as the National Health Reform Agreement (NHRA), MBS or PBS. Often the relationship under these schemes between the spending, the particular diseases or conditions being managed, and the demographic characteristics of the people whose care the spending is for, is complex. It can be difficult, for example, to precisely identify for a hospital stay involving someone suffering from a number of ailments and including a range of procedures and treatments, which expenses were related to which conditions. Health spending is also often associated with the management of symptoms and issues for which there is no specific diagnosis (for example, someone attending to an Emergency Department (ED) with abdominal pain for which no specific cause can be identified).

The aim of this report is to use a range of modelling techniques to apportion health spending to population groups based on age, sex, and to disease expenditure groups using the ICD and the AIHW’s Australian Burden of Disease Study (ABDS) conditions as far as is possible. Due to data availability, allocated spending is skewed towards activity in hospitals, and estimates should be interpreted with this in mind.

This disease expenditure study largely draws upon previously published methods, the most recent being Health system spending on disease and injury in Australia, 2020–21 (AIHW 2023b). There were however changes made to the methods used for estimating the cost of services in public hospitals, allocating costs to specific conditions within disease groups, and the list of conditions that are included in the study. Data in this report should be used and are not directly comparable to data in earlier reports (AIHW 2019, AIHW 2021, AIHW 2022, AIHW 2023b). This report also includes comparisons with historical data (using these updated methods) so there is a consistent time series for 2013–14 to 2022–23.  Refer to the Technical notes and the accompanying methods report, Health system spending on disease and injury in Australia, 2022-23: Overview of analysis and methodology for further information. The methods report is available from the Related material section.

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