Admitted patient care in public and private hospitals
Why investigate the use of admitted patient care services in public and private hospitals?
The NHDH only enabled analysis of admitted patient care in private hospitals for a single jurisdiction (Queensland). Accordingly, the focus of the report was on public hospital data to provide a more nationally comprehensive view of admitted care use by ex-serving members. However, the absence of private hospital data for the analysis means that there is a downward bias in measuring mental health, alcohol and other drug and intentional self-harm presentations to hospital.
AIHW undertook analysis of Queensland (as the only jurisdiction with sufficient data) to provide insights on total admitted patient care, including both public and private hospital care. This enabled comparison of trends in admitted patient care for ex-serving ADF members between public and private hospitals and public hospitals only. Given this analysis was only based on Queensland there may be jurisdictional differences that can not be controlled for when making comparisons. AIHW is working with other jurisdictions to enable the inclusion of private hospital data in the NHDH to extend this analysis in the future.
Public and private hospital admissions
The most common principal diagnoses among ex-serving ADF members and the total Queensland population admitted to public and private hospitals in Queensland were different to those for public hospital only admissions.
Of all patients admitted to a public or private hospital in Queensland (FY 2019-20), a higher proportion of ex-serving ADF members than the comparable Queensland population were admitted for:
- musculoskeletal conditions (males:18.1% vs 11.1%; females: 15.8% vs 10.0%)
- mental and behavioural disorders (males: 7.5% vs 4.3%; females: 6.4% vs 3.4%).
Note that this pattern is similar to the proportions based on the public hospital data (males: 7.1% vs 5.7%; females: 5.0% vs 4.2%).
Age
Differences in the reasons for admission among the ex-serving ADF population and comparable Queensland population were greater among select age groups and conditions. Of patients admitted to Queensland public and private hospitals in 2019-2020, compared to all Queenslanders (see supplementary table S.QLD.1.2):
- a higher proportion of male ex-serving ADF members aged 25-34 years were admitted for musculoskeletal conditions (19.1% vs 10.3%)
- a higher proportion of male ex-serving ADF members aged 35-44 years were admitted for mental and behavioural disorders (16.5% vs 8.0%)
- a higher proportion of female ex-serving ADF members aged 17-24 years were admitted for musculoskeletal conditions (17.5% vs 3.6%)
- a higher proportion of female ex-serving ADF members aged 25-34 years were admitted for mental and behavioural disorders (8.1% vs 3.6%).
DVA client status
Ex-serving DVA clients are a sub-population of ex-serving ADF members and have different characteristics to the all ex-serving ADF cohort. ADF members who are eligible for DVA support – and who access services funded by DVA – are more likely to have physical and mental health needs that would have led them to DVA. The reasons for admissions to hospital differed between DVA clients and non-DVA clients (see supplementary table S.QLD.1.3).
Of ex-serving patients admitted to Queensland (public and private) hospitals (FY 2019-20), compared to non-DVA clients:
- a higher proportion of male and female DVA clients were admitted for mental and behavioural disorders (males 9.8% vs 4.4%; females 10.6% vs 3.8%)
- note that this pattern is similar to the rates based on the public hospital data (males: 8.5% vs 6.1%; females: 6.1% vs 4.6%)
- a higher proportion of male and female DVA clients were admitted for musculoskeletal conditions (males 23.2% vs 11.1%; females 22.5% vs 11.4%)
- a higher proportion of male DVA clients were admitted for neoplasms (16.3% vs 12.7%) which contrasts with that of the public hospital analysis where more female DVA clients were admitted for neoplasms.
Mental and behavioural disorders
Of all admitted patients to public and private hospitals in Queensland (FY 2019-20):
- a higher proportion of ex-serving ADF males for all age groups except 65+ were admitted for a mental and behavioural disorder compared to the Queensland population (Table 11)
- a higher proportion of ex-serving ADF females for all age groups except 17-24 and 65+ were admitted for a mental and behavioural disorder compared to the Queensland population
Age | Males | Qld | Proportion difference | Females | Qld | Proportion difference |
|---|---|---|---|---|---|---|
17-24 | 9.0 | 8.7 | 0.3 (-4.2-,4.8) | 9.3 | 5.8 | 3.5 |
25-34 | 16.6 | 9.0 | 7.6 (5.3,9.9) | 8.1 | 3.6 | 4.6 (1.9,7.3) |
35-44 | 16.5 | 8.0 | 8.5 (6.9,10.2) | 8.2 | 4.0 | 4.3 (2.2,6.4) |
45-54 | 9.0 | 5.2 | 3.8 (3.0,4.7) | 6.7 | 4.1 | 2.6 (1.2,3.9) |
55-64 | 5.0 | 2.5 | 2.4 (1.8,3.1) | 4.6 | 2.6 | 2.0 (0.5,3.4) |
65+ | 2.9 | 2.2 | 0.7 (0.3,1.2) | 3.0 | 2.5 | 0.5 |
All ages 17+ | 7.5 | 4.3 | 3.2 (2.7,3.6) | 6.4 | 3.4 | 3.1 (2.2, 3.9) |
Source: AIHW analysis of linked Defence Historical Personnel data–PMKeyS–DVA client–NDI–MCD–NHMD-NNAPEDCD–MBS–PBS–RPBS data (2010–2020) and AIHW NHDH (2019-2020)
Notes
n.p. Suppressed due to small numbers, or to prevent subsequent disclosure of cells with small numbers.
Different vetting and release approval practices apply to the different data sources.
Bolding indicates statistical significance was found for the difference between the proportions.
- Includes ADF members with at least one day of service since 1 January 1985 who were ex-serving (separated from permanent and/or reserve ADF service) and alive at any point from 1 July 2010 to 30 June 2020.
- By year of separation from hospital stay, for separations between 1 July 2010 and 30 June 2020.
- Includes stay separations that occurred while ex-serving (for ex-serving members) and where patients were aged 17 years or older at admission.
- By age at admission. Patients may be reported in up to two age groups if a change in age during the analysis period causes them to be assigned into the subsequent age group for later admissions.
- Where a stay includes more than one episode, the principal diagnosis of the initiating episode is used.
- Excludes stays where the principal diagnosis was in the ICD-10-AM chapter 'Certain conditions originating in the perinatal period' or 'Codes for special purposes'.
- Includes public and private hospital data from Queensland. Additional data for ex-serving members was provided by the Department of Veterans' Affairs (DVA) for DVA-funded admitted patient care in Queensland.
Military characteristics
As a proportion of patients in public and private Queensland hospitals (2019-20), a principal diagnosis of mental and behavioural disorders was more common in ex-serving ADF males with:
- Army or Navy service (compared to RAAF service)
- Length of service less than one year, between 1 and less than 5 years and between 5 and less than 10 years (compared to longer service periods)
- Other ranks – junior and unspecified (compared to officers and senior other ranks)
- Involuntary medical separation (compared to other involuntary and voluntary separation)
These patterns were similar for the analysis based on public hospital data only.
Admission for mental health-related care by diagnostic group
This section presents analysis of the types of mental health-related care for admitted patients using a broader definition of mental health than mental and behavioural disorders. Mental health-related care was defined using the same classification that is used in AIHW reporting conventions when analysing the Australian population.
In 2019-20, a higher proportion of admitted ex-serving males were admitted to Queensland hospitals for mental health-related care compared to all admitted Queensland males (8.0% vs. 5.0%). This pattern was true for ex-serving males across all age groups apart from 17-24 in comparison to Queensland males. The difference was most significant for ex-serving males aged 35-44 years (17.2% vs. 8.9%).
The proportion of ex-serving females admitted for mental health-related care in Queensland was higher in comparison to Queensland females (6.9% vs. 3.9%). This pattern was true for ex-serving females across all age groups apart from 17-24 and 65+ in comparison to Queensland females. The difference was most significant for ex-serving females aged 25-34 years (8.7% vs. 4.4%).
Figure 2 compares the distribution of mental health-related care across the male and female ex-serving ADF member and total Queensland populations admitted to a public or private hospital in Queensland hospitals for any mental health-related care. Stress-related disorders and depression were the top mental health-related care types for ex-serving ADF males and females, respectively, whereas mental health related to alcohol and other drugs was the leading mental health-related care type for the total Queensland population.
Figure 2: Proportion of all admissions for any mental health-related care by principal diagnosis group for male and female ex-serving ADF members and all Queenslanders aged 17 and over to a public and private hospital in Queensland, 2019-20.
Source: AIHW analysis of linked Defence Historical Personnel data–PMKeyS–DVA client–NDI–MCD–NHMD-NNAPEDCD–MBS–PBS–RPBS data (2010–2020) and AIHW NHDH (2019-2020)
Notes:
n.p. Suppressed due to small numbers, or to prevent subsequent disclosure of cells with small numbers.
Different vetting and release approval practices apply to the different data sources
- Includes ADF members with at least one day of service since 1 January 1985 who were ex-serving (separated from permanent and/or reserve ADF service) and alive at any point from 1 July 2010 to 30 June 2020.
- By year of separation from hospital stay, for separations between 1 July 2010 and 30 June 2020.
- Includes stay separations that occurred while ex-serving (for ex-serving members) and where patients were aged 17 years or older at admission.
- By age at admission. Patients may be reported in up to two age groups if a change in age during the analysis period causes them to be assigned into the subsequent age group for later admissions.
- Where a stay includes more than one episode, the principal diagnosis of the initiating episode is used.
- Excludes stays where the principal diagnosis was in the ICD-10-AM chapter 'Certain conditions originating in the perinatal period' or 'Codes for special purposes'.
- Includes public and private hospital data from Queensland. Additional data for ex-serving members was provided by the Department of Veterans' Affairs (DVA) for DVA-funded admitted patient care in Queensland.
Of patients admitted to Queensland hospitals (FY 2019-20), compared to Queenslanders by age group:
- a higher proportion of ex-serving ADF males aged 35-44 years were admitted for mental health-related care (17.2% vs 8.9%)
- a higher proportion of ex-serving ADF females aged 35-44 years were admitted for mental health-related care (8.7% vs 4.4%)
- a higher proportion of ex-serving ADF males aged 35-44 years were admitted for stress-related disorders (7.6% vs 1.1%) – for all males about 40% of mental health-related care were stress-related disorders compared to 10% for all Queensland males
- a higher proportion of ex-serving ADF males aged 25-34 years were admitted for depression (4.0% vs 1.3%)
- a higher proportion of ex-serving ADF males aged 35-44 years were admitted for mental health-related drug and alcohol conditions (4.5% vs 3.4%).
Military characteristics
As a proportion of patients admitted in Queensland hospitals (FY 2019-20):
- 10.4% of male DVA clients and 11.2% of female DVA clients were admitted for mental health-related care, compared to 4.9% of male non-DVA clients and 4.2% of female non-DVA clients
- 22.0% of male and 16.3% of female ex-serving ADF members who had involuntarily separated for medical reasons were admitted for mental health-related care; this compares to 8.5% of male and 4.6% of female ex-serving who separated for voluntary reasons admitted for mental health-related care
- ex-serving males with a length of service from 5 to less than 10 years (4.4%) and females with a length of service greater than 10 years (2.6%) represented a greater proportion of persons admitted for stress-related disorders.
The analysis of public hospital-only data showed that similar service characteristics were associated with a greater proportion of ex-serving ADF members being admitted for mental health-related care.
Alcohol and other drug use
Of patients admitted to Queensland hospitals (FY 2019-20), compared to all admitted Queenslanders:
- a higher proportion of ex-serving males were admitted for alcohol and other drug related conditions (2.8% vs 2.4%), of which a greater proportion were admitted for alcohol use (63.9% vs 49.3%)
- a similar proportion of ex-serving females were admitted for alcohol and other drug related conditions. However, there was a higher proportion of ex-serving females admitted for alcohol and other drugs in most years between 2010 and 2020 (except for 2013-14 and 2019-20).
Table 12 shows that among the substances leading to admission at public and private hospitals, alcohol was the most common substance. Similar findings were seen in those admitted to public hospitals.
Rank | Principal diagnosis | Ex-serving males | Queensland | Ex-serving females | Queensland females |
|---|---|---|---|---|---|
1 | Alcohol | 63.9 | 49.3 | 41.9 | 38.3 |
2 | Anti-epileptic, sedative -hypnotic and antiparkinsonian drugs | 9.8 | 10.2 | 14.5 | 14.6 |
3 | Opioids | 8.1 | 7.1 | 11.3 | 6.6 |
Source: AIHW analysis of linked Defence Historical Personnel data–PMKeyS–DVA client–NDI–MCD–NHMD-NNAPEDCD–MBS–PBS–RPBS data (2010–2020) and AIHW NHDH (2019-2020)
Notes
n.p. Suppressed due to small numbers, or to prevent subsequent disclosure of cells with small numbers.
Different vetting and release approval practices apply to the different data sources
1) Includes ADF members with at least one day of service since 1 January 1985 who were ex-serving (separated from permanent and/or reserve ADF service) and alive at any point from 1 July 2010 to 30 June 2020.
2) By year of separation from hospital stay, for separations between 1 July 2010 and 30 June 2020.
3) Includes stay separations that occurred while ex-serving (for ex-serving members) and where patients were aged 17 years or older at admission.
4) By age at admission. Patients may be reported in up to two age groups if a change in age during the analysis period causes them to be assigned into the subsequent age group for later admissions.
5) Where a stay includes more than one episode, the principal diagnosis of the initiating episode is used.
6) Excludes stays where the principal diagnosis was in the ICD-10-AM chapter 'Certain conditions originating in the perinatal period' or 'Codes for special purposes'.
7) Includes public and private hospital data from Queensland. Additional data for ex-serving members was provided by the Department of Veterans' Affairs (DVA) for DVA-funded admitted patient care in Queensland
Of patients admitted to public and private Queensland hospitals (FY2019-20), compared to all Queenslanders:
- a higher proportion of ex-serving ADF males aged 35-44 were admitted for an alcohol-related condition (3.5% vs 2.3%)
- a greater proportion of male ex-serving ADF members admitted for any alcohol or drug use aged 35-44 or 55-64 were admitted for alcohol use compared to all Queensland males (See Supplementary Table S.QLD.3.2)
- a higher proportion of Army (3.0%) and Navy (3.4%) than RAAF (1.6%) were admitted for alcohol-related conditions
- a higher proportion of ex-serving ADF males with an involuntary medical separation (6.0%) were admitted for an alcohol and other drug related condition than those with a voluntary separation (3.5%)
- a higher proportion of ex-serving ADF males with lengths of service less than 1 year (4.9%) or 1 to less than 5 years (4.9%) were admitted for any alcohol and other drug-related condition than those with more than 20 years of service (2.1%)
- a higher proportion of ex-serving ADF males who separated in ‘other ranks’ (3.7%) were admitted for any alcohol and other drug-related condition than officers (1.9%) and senior other ranks (1.3%).
Intentional self-harm
In FY 2019-20, 113 male ex-serving ADF members and 31 female ex-serving ADF members were admitted for intentional self-harm in Queensland hospitals.
Similar proportions of ex-serving ADF members and Queensland population were admitted to public and private hospitals for intentional self-harm. This was the same across all age groups with sufficient data for both males and females.
This trend contrasts with the higher proportion of ex-serving ADF members than Australian population admitted for intentional self-harm in public hospitals.
The service characteristics associated with ex-serving ADF members admitted to public and private hospitals for intentional self-harm were similar to that based on the public hospital-only analysis.
Summary
The purpose of the analysis of Queensland public and private hospitals was to compare and contrast the findings with the analysis of public hospitals across most Australian jurisdictions for ex-serving members. Noting that analysis of both public and private hospitals could be more beneficial if there was data from more jurisdictions to account for Queensland-specific factors, there were mostly similar themes across each analysis, with some differences. Comparing the two sets of analysis:
- There were similar findings for mental and behavioural disorders and mental health-related care
- Mental and behavioural disorders and mental health-related care as a proportion of admitted care was higher for ex-serving ADF members than the comparator Australian or Queensland population.
- There were similar findings for alcohol and drug use for males
- A higher proportion of ex-serving males were admitted for alcohol and other drug related conditions, of which a greater proportion were admitted for alcohol use.
- There were similar findings for military characteristics of ex-serving members with the following having a higher association with conditions related to suicidal behaviour:
- Army or Navy service
- shorter lengths of service
- lower rank
- involuntary medical separation.
The two sets of analysis did show some different findings which could suggest a greater need to consider the role of private hospitals in future analysis:
- The most common reasons that patients were admitted to public hospitals was different compared to public and private hospitals for ex-serving members and all admitted Australians.
- The top 3 reasons for admission in public hospitals were: symptoms and signs, injury and poisoning and digestive diseases.
- The top 3 reasons for admission in Queensland hospitals were: digestive diseases, symptoms and signs and musculoskeletal conditions.
- The proportion of admissions for intentional self-harm was higher for ex-serving members compared to all admitted Australians based on public hospital data but there were similar proportions of admission for intentional self-harm based on the Queensland hospital analysis. This could have been a result of small figures in the Queensland analysis.