Brian Hanning - Academia.edu (original) (raw)

Papers by Brian Hanning

Research paper thumbnail of Impact on public hospitals if private health insurance rates in Victoria declined

Australian Health Review, Dec 13, 2004

The additional cost of treating acute care type Victorian private patients as public patients in ... more The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.31.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.3385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public Aust Health Rev 2004: 28(3): 330-339 hospitals would be increased, not decreased.

Research paper thumbnail of New activity-based funding model for Australian private sector overnight rehabilitation cases: the rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model

Australian health review : a publication of the Australian Hospital Association, Jan 2, 2015

Traditional overnight rehabilitation payment models in the private sector are not based on a rigo... more Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Envi...

Research paper thumbnail of Impact on public hospitals if private health insurance rates in Victoria declined

Australian Health Review, 2004

The additional cost of treating acute care type Victorian private patients as public patients in ... more The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.31.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.3385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public Aust Health Rev 2004: 28(3): 330-339 hospitals would be increased, not decreased.

Research paper thumbnail of Combining DRGs and per diem payments in the private sector: the Equitable Payment Model

Australian Health Review, 2005

The many types of payment models used in the Australian private sector are reviewed. Their featur... more The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM TM (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM TM being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM TM for hospitals and health Aust Health Rev 2005: 29(1): 80-86 funds are outlined.

Research paper thumbnail of Are Victorian elective surgery cases still converting from overnight to same day cases?

Australian Health Review, 2005

The many types of payment models used in the Australian private sector are reviewed. Their featur... more The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM TM (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM TM being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM TM for hospitals and health Aust Health Rev 2005: 29(1): 80-86 funds are outlined.

Research paper thumbnail of Length of stay benchmarking in the Australian private hospital sector

Australian Health Review, 2007

Length of stay (LOS) benchmarking is a means of comparing hospital efficiency. Analysis of privat... more Length of stay (LOS) benchmarking is a means of comparing hospital efficiency. Analysis of private cases in private facilities using Australian Institute of Health and Welfare (AIHW) data shows interstate variation in same-day (SD) cases and overnight average LOS (ONALOS) on an Australian Refined Diagnosis Related Groups version 4 (ARDRGv4) standardised basis. ARDRGv4 standardised analysis from 1998-99 to 2003-04 shows a steady increase in private sector SD cases (approximately 1.4% per annum) and a decrease in ONALOS (approximately 4.3% per annum). Overall, the data show significant variation in LOS parameters between private hospitals.

Research paper thumbnail of Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?

Australian Health Review, 2002

Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The b... more Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1. The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002. Limited data from other states suggests the Victorian trends are representative of all Australia.

Research paper thumbnail of Will health fund rationalisation lead to significant premium reductions?

Australian Health Review, 2003

It has been suggested that rationalisation of health funds will generate significant albeit unqua... more It has been suggested that rationalisation of health funds will generate significant albeit unquantified cost savings and thus hold or reduce health fund premiums. 2001-2 Private Health Industry Administration Council (PHIAC) data has been used to analyse these suggestions. Payments by funds for clinical services will not vary after fund rationalisation. The savings after rationalisation will arise from reductions in management expenses, which form 10.9% of total fund expenditure. A number of rationalisation scenarios are considered. The highest theoretical industry wide saving found in any plausible scenario is 2.5%, and it is uncertain whether this level of saving could be achieved in practice. If a one off saving of this order were achieved, it would have no medium and long term impact on fund premiums increases given funds are facing cost increases of 4% to 5% per annum due to demographic changes and age standardised utilization increases. It is suggested discussions on fund amalgamation divert attention from the major factors increasing fund costs, which are substantially beyond fund control.

Research paper thumbnail of Some demographic issues affecting private health insurance

Australian Health Review, 2004

There will be significant changes in the demography of persons with Private Health Insurance (PHI... more There will be significant changes in the demography of persons with Private Health Insurance (PHI). Two methods of projecting PHI coverage are discussed in this paper. The first assumes the only factors affecting PHI coverage are demographic change and mortality, and facilitates comparisons between actual and projected PHI coverage. The second projects the percentage of the population insured in each five year age cohort, and makes allowance for changes in PHI coverage due to all factors. Demographic change will increase Registered Health Benefit Organization (RHBO) premiums by 1.7% per annum. The role of these projections in analysing the effect of future premium increases on PHI retention rates is also discussed.

Research paper thumbnail of Private care and public waiting

Australian Health Review, 2005

Waiting time for public hospital care is a regular matter for political debate One political resp... more Waiting time for public hospital care is a regular matter for political debate One political response has been to suggest that expanding private sector activity will reduce public waiting times. This paper tests the hypothesis that increased private activity in the health system is associated with reduced waiting times using secondary analysis of hospital activity data for 2001-02.

Research paper thumbnail of Impact on public hospitals if private health insurance rates in Victoria declined

Australian Health Review, Dec 13, 2004

The additional cost of treating acute care type Victorian private patients as public patients in ... more The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.31.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.3385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public Aust Health Rev 2004: 28(3): 330-339 hospitals would be increased, not decreased.

Research paper thumbnail of New activity-based funding model for Australian private sector overnight rehabilitation cases: the rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model

Australian health review : a publication of the Australian Hospital Association, Jan 2, 2015

Traditional overnight rehabilitation payment models in the private sector are not based on a rigo... more Traditional overnight rehabilitation payment models in the private sector are not based on a rigorous classification system and vary greatly between contracts with no consideration of patient complexity. The payment rates are not based on relative cost and the length-of-stay (LOS) point at which a reduced rate applies (step downs) varies markedly. The rehabilitation Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) model (RAM), which has been in place for over 2 years in some private hospitals, bases payment on a rigorous classification system, relative cost and industry LOS. RAM is in the process of being rolled out more widely. This paper compares and contrasts RAM with traditional overnight rehabilitation payment models. It considers the advantages of RAM for hospitals and Australian Health Service Alliance. It also considers payment model changes in the context of maintaining industry consistency with Electronic Claims Lodgement and Information Processing System Envi...

Research paper thumbnail of Impact on public hospitals if private health insurance rates in Victoria declined

Australian Health Review, 2004

The additional cost of treating acute care type Victorian private patients as public patients in ... more The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.31.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be 1.05billionassumingallpatientswerestilltreated.Ifprivatehealthinsurance(PHI)uptakehaddeclinedto23.3385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public Aust Health Rev 2004: 28(3): 330-339 hospitals would be increased, not decreased.

Research paper thumbnail of Combining DRGs and per diem payments in the private sector: the Equitable Payment Model

Australian Health Review, 2005

The many types of payment models used in the Australian private sector are reviewed. Their featur... more The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM TM (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM TM being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM TM for hospitals and health Aust Health Rev 2005: 29(1): 80-86 funds are outlined.

Research paper thumbnail of Are Victorian elective surgery cases still converting from overnight to same day cases?

Australian Health Review, 2005

The many types of payment models used in the Australian private sector are reviewed. Their featur... more The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM TM (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM TM being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM TM for hospitals and health Aust Health Rev 2005: 29(1): 80-86 funds are outlined.

Research paper thumbnail of Length of stay benchmarking in the Australian private hospital sector

Australian Health Review, 2007

Length of stay (LOS) benchmarking is a means of comparing hospital efficiency. Analysis of privat... more Length of stay (LOS) benchmarking is a means of comparing hospital efficiency. Analysis of private cases in private facilities using Australian Institute of Health and Welfare (AIHW) data shows interstate variation in same-day (SD) cases and overnight average LOS (ONALOS) on an Australian Refined Diagnosis Related Groups version 4 (ARDRGv4) standardised basis. ARDRGv4 standardised analysis from 1998-99 to 2003-04 shows a steady increase in private sector SD cases (approximately 1.4% per annum) and a decrease in ONALOS (approximately 4.3% per annum). Overall, the data show significant variation in LOS parameters between private hospitals.

Research paper thumbnail of Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?

Australian Health Review, 2002

Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The b... more Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1. The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002. Limited data from other states suggests the Victorian trends are representative of all Australia.

Research paper thumbnail of Will health fund rationalisation lead to significant premium reductions?

Australian Health Review, 2003

It has been suggested that rationalisation of health funds will generate significant albeit unqua... more It has been suggested that rationalisation of health funds will generate significant albeit unquantified cost savings and thus hold or reduce health fund premiums. 2001-2 Private Health Industry Administration Council (PHIAC) data has been used to analyse these suggestions. Payments by funds for clinical services will not vary after fund rationalisation. The savings after rationalisation will arise from reductions in management expenses, which form 10.9% of total fund expenditure. A number of rationalisation scenarios are considered. The highest theoretical industry wide saving found in any plausible scenario is 2.5%, and it is uncertain whether this level of saving could be achieved in practice. If a one off saving of this order were achieved, it would have no medium and long term impact on fund premiums increases given funds are facing cost increases of 4% to 5% per annum due to demographic changes and age standardised utilization increases. It is suggested discussions on fund amalgamation divert attention from the major factors increasing fund costs, which are substantially beyond fund control.

Research paper thumbnail of Some demographic issues affecting private health insurance

Australian Health Review, 2004

There will be significant changes in the demography of persons with Private Health Insurance (PHI... more There will be significant changes in the demography of persons with Private Health Insurance (PHI). Two methods of projecting PHI coverage are discussed in this paper. The first assumes the only factors affecting PHI coverage are demographic change and mortality, and facilitates comparisons between actual and projected PHI coverage. The second projects the percentage of the population insured in each five year age cohort, and makes allowance for changes in PHI coverage due to all factors. Demographic change will increase Registered Health Benefit Organization (RHBO) premiums by 1.7% per annum. The role of these projections in analysing the effect of future premium increases on PHI retention rates is also discussed.

Research paper thumbnail of Private care and public waiting

Australian Health Review, 2005

Waiting time for public hospital care is a regular matter for political debate One political resp... more Waiting time for public hospital care is a regular matter for political debate One political response has been to suggest that expanding private sector activity will reduce public waiting times. This paper tests the hypothesis that increased private activity in the health system is associated with reduced waiting times using secondary analysis of hospital activity data for 2001-02.