Private outPrivate out--ofof--pocket expenditure pocket expenditure in Australiain Australia’’s Health Accountss Health Accounts

Lindy InghamLindy InghamSenior AnalystSenior Analyst

Australian Institute of Health and Australian Institute of Health and WelfareWelfare

Overview of presentationOverview of presentation

Sources of private outSources of private out--ofof--pocket pocket expenditure dataexpenditure data

oo Administrative byAdministrative by--productproductoo ABS census and survey dataABS census and survey dataoo Industry dataIndustry data

Statistics on AustraliaStatistics on Australia’’s outs out--ofof--pocket expenditure on healthpocket expenditure on health

YearYear AmountAmount

$ billion$ billion

Percentage Percentage share of total share of total

health health expenditureexpenditure

%%

19921992--9393 6.06.0 18.218.2

20022002--0303 14.514.5 20.720.7

Private outPrivate out--ofof--pocket expenditure in pocket expenditure in 20022002--03, allocated by type of data 03, allocated by type of data

sourcesourceAmountAmount

$ billion$ billion

Percentage share of Percentage share of total outtotal out--ofof--pocket pocket

expenditureexpenditure%%

Administrative Administrative byby--productproduct 3.6 3.6 2525ABS dataABS data 7.27.2 5050Industry dataIndustry data 3.73.7 2525TotalTotal 14.514.5 100100

Area of expenditure by type of dataArea of expenditure by type of dataArea of expenditureArea of expenditure Private outPrivate out--ofof--pocket pocket

expenditure $ millionexpenditure $ millionType of data sourceType of data source

Medical servicesMedical services 1,4231,423 Administrative byAdministrative by--productproduct

Benefit paid pharmaceuticalsBenefit paid pharmaceuticals 951951 Administrative byAdministrative by--productproduct

HighHigh--level residential carelevel residential care 903903 Administrative byAdministrative by--productproduct

Public hospitalsPublic hospitals 331331 Administrative byAdministrative by--productproduct

Dental servicesDental services 2,9692,969 ABSABS

AmbulanceAmbulance 393393 ABS and PHIACABS and PHIAC

Private hospitalsPrivate hospitals 266266 ABSABS

Other professional servicesOther professional services 1,5761,576 ABSABS

Aids and appliancesAids and appliances 1,9871,987 ABSABS

All other pharmaceuticalsAll other pharmaceuticals 3,6873,687 IndustryIndustry

Total private Total private oopoop expenditureexpenditure 14,48614,486

Administrative byAdministrative by--product dataproduct data

Medical servicesMedical servicesBenefitBenefit––paid pharmaceuticalspaid pharmaceuticalsHighHigh--level residential carelevel residential carePublic hospitalsPublic hospitals

Medical ServicesMedical Services

Provider data sourceProvider data source–– Australian Government Department of Health Australian Government Department of Health

and Ageingand AgeingMedical Benefits SchemeMedical Benefits Scheme

Derived by:Derived by:-- Fees charged less Benefits paidFees charged less Benefits paid

BenefitBenefit--paid pharmaceuticalspaid pharmaceuticals

Provider data sourceProvider data source–– Australian Government Department of Health and Australian Government Department of Health and

AgeingAgeingPharmaceuticals Benefits Scheme (PBS)Pharmaceuticals Benefits Scheme (PBS)

–– Australian Government Department of VeteransAustralian Government Department of Veterans’’ AffairsAffairsRepatriation Pharmaceuticals Benefits Scheme (RPBS)Repatriation Pharmaceuticals Benefits Scheme (RPBS)

Derived by:Derived by:-- Patient contributionPatient contribution

HighHigh--level residential carelevel residential care

Provider data sourceProvider data source–– Australian Government Department of Health Australian Government Department of Health

and Ageingand AgeingAged and Community Care Management Aged and Community Care Management Information System (ACCMIS) database.Information System (ACCMIS) database.

Derived by:Derived by:-- Client feesClient fees

Public hospitalsPublic hospitals

Provider data sourceProvider data source–– Operating statements of Public nonOperating statements of Public non--psychiatric psychiatric

and psychiatric hospitalsand psychiatric hospitalsAustralian Institute of Health and WelfareAustralian Institute of Health and Welfare’’s s National Public Hospital Establishments National Public Hospital Establishments DatabaseDatabase

Derived by:Derived by:-- Patient revenuePatient revenue

ABS dataABS data

Private hospitals Establishments Collection Private hospitals Establishments Collection for:for:–– Private hospitalsPrivate hospitalsHousehold final consumption expenditure Household final consumption expenditure (HFCE) for:(HFCE) for:–– Other professional servicesOther professional services–– Aids and appliancesAids and appliances–– Dental servicesDental services–– AmbulanceAmbulance

Establishments Collection for Private Establishments Collection for Private hospitalshospitals

Annual census of all licensed private Annual census of all licensed private hospitals in Australiahospitals in Australia

Data item : Patient revenueData item : Patient revenue

Household final consumption Household final consumption expenditureexpenditure

ByBy--product of ABS National Accountsproduct of ABS National AccountsCovers all personal outlays on health Covers all personal outlays on health products and services but excludes:products and services but excludes:–– Medicare levyMedicare levy–– Refunds from MedicareRefunds from Medicare--covered servicescovered services

Aids and appliancesAids and appliances

HFCE Medicines, aids and appliancesHFCE Medicines, aids and appliances–– less patient contribution from PBS and RPBSless patient contribution from PBS and RPBS–– less private expenditure on all other less private expenditure on all other

pharmaceuticals (to be discussed later)pharmaceuticals (to be discussed later)–– equals equals private outprivate out--ofof--pocket expenditure for pocket expenditure for

aids and appliancesaids and appliances

Aids and appliancesAids and appliances

Source: Retail Trade census ( approximately Source: Retail Trade census ( approximately 5 yearly) supplemented by monthly retail 5 yearly) supplemented by monthly retail sales surveysales surveyBut AIHW consider the scope of ABS retail But AIHW consider the scope of ABS retail trade census is too narrow as it:trade census is too narrow as it:–– omits sales from specialty medical device omits sales from specialty medical device

shops, and disease based organisations such shops, and disease based organisations such as Diabetes Australia, etc.as Diabetes Australia, etc.

Other professional servicesOther professional services

HFCE Doctors and other professional HFCE Doctors and other professional servicesservices–– less patient contribution from medical servicesless patient contribution from medical services–– equals equals private outprivate out--ofof--pocket expenditure on pocket expenditure on

other professional servicesother professional services

Source: Australian Taxation Office dataSource: Australian Taxation Office data

Dental servicesDental services

HFCE dentistsHFCE dentists–– Based on the gross income of dentistsBased on the gross income of dentists–– equals equals private outprivate out--ofof--pocket expenditure on pocket expenditure on

dental servicesdental services

Source: Australian Taxation Office dataSource: Australian Taxation Office data

Ambulance servicesAmbulance services

Based on HFCE Ambulance, which is no Based on HFCE Ambulance, which is no longer produced separately by ABSlonger produced separately by ABSMovements in estimates of benefits paid by Movements in estimates of benefits paid by private health funds for ambulance services private health funds for ambulance services applied to HFCE Ambulance applied to HFCE Ambulance –– equals equals private outprivate out--ofof--pocket expenditure for pocket expenditure for

ambulance servicesambulance servicesSource: Private health insurance advisory Source: Private health insurance advisory council data and ABScouncil data and ABS

Industry dataIndustry data

““All other pharmaceuticalsAll other pharmaceuticals”” –– pharmaceuticals for pharmaceuticals for which no PBS or RPBS is paidwhich no PBS or RPBS is paidIncludes:Includes:–– pharmaceuticals listed in the PBS or RPBS, the total costs of whpharmaceuticals listed in the PBS or RPBS, the total costs of which ich

are equal to, or less than, the statutory patient contribution fare equal to, or less than, the statutory patient contribution for the or the class of patient concernedclass of patient concerned

–– medicines dispensed through private prescriptions for items not medicines dispensed through private prescriptions for items not listed in the PBS or RPBSlisted in the PBS or RPBS

–– overover--thethe--counter medicines such as aspirin, cough and cold counter medicines such as aspirin, cough and cold medicines, vitamins and minerals, some herbal and other medicines, vitamins and minerals, some herbal and other complementary medicines, and a range of medical complementary medicines, and a range of medical nonnon--durables, such as bandages, band aids and condoms.durables, such as bandages, band aids and condoms.

Private prescriptions and Private prescriptions and prescriptions under coprescriptions under co--paymentpayment

Provider data sourceProvider data source–– Pharmacy GuildPharmacy Guild

Drug Utilisation Sub CommitteeDrug Utilisation Sub Committee

OverOver--thethe--counter pharmaceuticalscounter pharmaceuticals

Provider data sourceProvider data source–– Annual publication:Annual publication: Retail PharmacyRetail Pharmacy

OTC pharmaceuticals sold through OTC pharmaceuticals sold through pharmaciespharmacies

–– Annual publication:Annual publication: Retail WorldRetail WorldOTC pharmaceuticals sold through OTC pharmaceuticals sold through supermarketssupermarkets

OverOver--thethe--counter pharmaceuticalscounter pharmaceuticals

Have unit price and sales volume dataHave unit price and sales volume data–– from over 70 major grocery manufacturers from over 70 major grocery manufacturers

((Retail WorldRetail World) and) and–– from over 330 large pharmacy stores in from over 330 large pharmacy stores in

Australia, grossed to Australian totals by Aztec Australia, grossed to Australian totals by Aztec Information Systems (Information Systems (Retail PharmacyRetail Pharmacy))

No data on sales of OTC pharmaceuticals No data on sales of OTC pharmaceuticals through convenience stores (thought to be through convenience stores (thought to be insignificant)insignificant)

Link to our latest publicationLink to our latest publication

http://www.aihw.gov.au/publications/index.cfmhttp://www.aihw.gov.au/publications/index.cfm/title/10204/title/10204