Healthcare costs and outcomes in the workers compensation and CTP scheme accessible version

For the 12 month period ending 30 June 2020

Accessible version

Definition of ‘healthcare’ used in this report

Within this report, healthcare encompasses the following services only:
Medical & investigation services
Surgery
Diagnostic & therapeutic procedures, nuclear medicine, radiation, ultrasound, MRI etc
Ambulance services
Pharmaceutical services
Allied health services
Hospital services – public & private
Care – domestic, personal and nursing
Aids & appliances
Dental related services

Summary of key observations

Workers Compensation

Healthcare expenditure growth in the workers compensation scheme continues to grow, though at a slower rate (0.75%, or $7.1M) in FY2019/20* (most likely due to the impact of COVID) with service utilisation continuing to be the primary contributor to increasing healthcare costs.
This slower growth was driven by reductions in:
- unit cost per service across the scheme (i.e. the average cost of a service). This result is driven primarily by reductions in surgery and hospital services.
- the number of claims accessing healthcare.
Allied health services continued to be the fastest growing service group in terms of expenditure, increasing by 10% between FY2018/19 and FY2019/20. This was driven by increases in physiotherapy, exercise physiology and psychology service utilisation.
Attendance (GP services and specialist consultations) in FY2019/20 also grew, driven by increases in GPs attendance. In the last 6 months of FY2019/20 telepsychiatry and report writing/case conferencing showed an increasing trend.

CTP (MAIA scheme)

Healthcare expenditure in CTP continues to grow as the 2017 MAIA Scheme matures, driven primarily by increasing claims and service utilisation.
Unit cost (average cost per service) in CTP has shown a reduction between FY2018/19 and FY2019/20. This could be due to the maturing nature of the scheme, and/or impact from COVID.
As the CTP scheme is only in its third year of operations at the date of data used*, it is challenging to draw conclusions on healthcare trends until the scheme reaches a steady state.

Note: Data is as at December 2020. Results for the later half of FY2019/20 will continue to mature.

Healthcare costs in the 12 months ending 30 June 2020 (data as at 31 December 2020)

Healthcare in WC scheme

$953m spent on healthcare services
0.75% increase in healthcare spend from previous 12 months
162.6K claims with healthcare payments
$5859 spent on healthcare services per claim
Mix of service group by expenditure in workers compensation scheme
Allied health services: 22%
Hospital: 20%
Surgery: 18%
Attendance: 17%
Care: 13%
Diagnostics: 7%
Pharmaceutical services: 2%
Refund payments: 1%
Dental related services: 0%
Ambulance: 0%
Time to treatment in workers compensation scheme
Before lodgement: 63% (average -13.24 days)
0 to 4 weeks: 34% (average 2.87 days)
5 weeks plus: 3% (average 86.18 days)

Healthcare in MAIA CTP scheme

$96m spent on healthcare services
37% increase in healthcare spend from previous 12 months
14.5K claims with healthcare payments
$6,620 spent on healthcare services per claim
The 2017 MAIA scheme is continuing to mature. It is challenging to draw conclusions on healthcare trends until the scheme reaches a steady state.
Mix of service group by expenditure in MAIA CTP scheme
Allied health services: 28%
Hospital: 19%
Surgery: 19%
Attendance: 16%
Care: 5%
Diagnostics: 7%
Pharmacy: 1%
Aids and appliances: 3.55%
Dental: 1%
Ambulance: 0%
Time to treatment in 2017 MAIA CTP scheme
Before lodgement: 75% (average -22.95 days)
0 to 4 weeks: 19% (average 8.38 days)
5 weeks plus: 6% (average 71.25 days)

Trends in healthcare expenditure by financial year

WC healthcare expenditure by service financial year

FY2017: $711.95m
FY2018: $796.11m
FY2019: $945.53m
FY2020: $952.63m
Healthcare expenditure in the workers compensation scheme grew at a slower rate (0.75%, or $7.1M) from FY2019 to FY 2020 primarily due to the impact of COVID

MAIA CTP healthcare expenditure by service financial year

FY2018: $18.7m
FY2019: $70.1m
FY2020: $96.0m
Healthcare expenditure experienced growth in the MAIA scheme from FY2019 to FY2020 of 37%, or $25.9M, as the scheme continues to develop

Drivers of workers compensation healthcare costs for the 12 months to 30 June 2020

In FY2019/20 total workers compensation healthcare costs increased by $7.1M (or 0.75%) to $952.63M (Refer to Appendix 1 for more information on how to interpret this chart)

Payments to June 2019: $945.5 millions
Payments to June 2020: $952.6 millions

During the 12-month period up to 30 June 2020, the number of claim and unit cost had negative contributions to overall expenditure with respective decreases of 1.43% and 3.64%. Service types per claim, Services per type per claim and inflation contributed additional expenditure of 1.78%, 2.68% and 1.36% respectively.

Drivers of workers compensation healthcare costs over the last three years

Over the last three financial years:

Service utilisation (comprised of service types per claim and services per service type) continues to be a constant source of positive growth.
Number of claims accessing healthcare services has seen large fluctuations.
Unit cost (i.e. average cost of services) has also seen fluctuations as a driver of healthcare expenditure over the past three financial years.
Inflation has added to growing healthcare expenditure at slightly declining rate.

Changes in the drivers of Workers Compensation healthcare expenditure by financial year, 2018, 2019, 2020

Number of claims: FY2018 $16,87m; FY2019 $71.11m; FY2020 -$13.49m
Service types per claim: FY2018 $25.16m; FY2019 $13.83m; FY2020 $16.87m
Services per service type: FY2018 $35.48m; FY2019 $49.62m; FY2020 $25.31m
Unit cost: FY2018 -$7.11m; FY2019 $10.75m; FY2020 -$34.41m
Inflation: FY2018 $13.77m; FY2019 $13.12m; FY2020 12.81m
NB: Amounts shown are the cost of the change in the healthcare driver when compared to the preceding financial year

Trends in the number of workers compensation claims receiving healthcare

For FY2019/20, the number of claims that received a healthcare service in the WC scheme reduced slightly from 164,893 to 162,581 (or - 1.4%).
In the last 6 months of FY2019/20, most insurer groups saw a decline in claims receiving healthcare. Most likely this is because of temporarily restricted access to services due to COVID, and the decrease in reportable claims.
The Nominal Insurer had a 2.37% drop in the number of claims accessing healthcare services, while TMF had an increase (1.46%).
Number of claims receiving a healthcare service by financial year
Year to June 2017: Nominal insurer 97245, TMF insurer 27257, Self insurer 14012, Specialised insurer 10181
Year to June 2018: Nominal insurer 99711, TMF insurer 27654, Self insurer 14008, Specialised insurer 10658
Year to June 2019: Nominal insurer 109127, TMF insurer 29704, Self insurer 14210, Specialised insurer 11852
Year to June 2020: Nominal insurer 106543, TMF insurer 30137, Self insurer 13934, Specialised insurer 11967

Trends in the number of healthcare service types per claim for workers compensation claims

The number of healthcare services between FY2019 & FY2020 increased 3%. The primary drivers in service type were allied health (+7%) and attendance (i.e. GP and specialist consultations) (+5%).
Care services (+7%) also increased over this period.
Reductions in the number of pharmacy, surgery, hospital and diagnostic services mitigated further growth in service utilisation overall.

Workers compensation – number of healthcare service types

FY2017: Allied health services 1188869, Attendance 1085589, Pharmaceutical services 421676, Care 250599, Surgery 154548, refund payments 4306
FY2018: Allied health services 1366099, Attendance 1116075, Pharmaceutical services 469965, Care 285440, Surgery 183817, refund payments 4411
FY2019: Allied health services 1640555, Attendance 1205429, Pharmaceutical services 504557, Care 368703, Surgery 205839, refund payments 3898
FY2020: Allied health services 1751281, Attendance 1264749, Pharmaceutical services 478387, Care 393452, Surgery 192258, refund payments 2768

Trends in the number of services per service type for workers compensation claims

Allied health

Year to June 2017: Physiotherapy services 749296, Exercise physiologists 177807, Psychological services 96451, Allied services not elsewhere classified 68098, Other therapies and treatments 58921, Chiropractor services 19726, Remedial massage 10234, Osteopathy services 5932, Counselling services 2401, Optometry and visual aids 3
Year to June 2018: Physiotherapy services 800743, Exercise physiologists 230591, Psychological services 119162, Allied services not elsewhere classified 93829, Other therapies and treatments 75484, Chiropractor services 23642, Remedial massage 11936, Osteopathy services 7390, Counselling services 3320, Optometry and visual aids 2
Year to June 2019: Physiotherapy services 900501, Exercise physiologists 294148, Psychological services 164619, Allied services not elsewhere classified 120337, Other therapies and treatments 98779, Chiropractor services 33244, Remedial massage 15649, Osteopathy services 8752, Counselling services 4524, Optometry and visual aids 2
Year to June 2020: Physiotherapy services 940788, Exercise physiologists 319986, Psychological services 195520, Allied services not elsewhere classified 130991, Other therapies and treatments 103399, Chiropractor services 30791, Remedial massage 15039, Osteopathy services 8235, Counselling services 6488, Optometry and visual aids 44

Attendance GP and specialist

Professional attendance (GP services): Q1 2016 160311, Q2 2016 167020, Q3 2016 169233, Q4 2016 161394, Q1 2017 164925, Q2 2017 166284, Q3 2017 170905, Q4 2017 166088, Q1 2018 169807, Q2 2018 176953, Q3 2018 186208, Q4 2018 184363, Q1 2019 190145, Q2 2019 193864, Q3 2019 207200, Q4 2019 199189, Q1 2020 198034, Q2 2020 187305
Professional attendance (Neurosurgery): Q1 2016 1753, Q2 2016 1897, Q3 2016 1887, Q4 2016 1928, Q1 2017 1784, Q2 2017 1905, Q3 2017 1976, Q4 2017 2037, Q1 2018 2002, Q2 2018 2310, Q3 2018 2271, Q4 2018 2154, Q1 2019 2393, Q2 2019 2403, Q3 2019 2472, Q4 2019 2331, Q1 2020 2244, Q2 2020 2523
Professional attendance (Other): Q1 2016 8372, Q2 2016 9189, Q3 2016 9501, Q4 2016 8640, Q1 2017 8963, Q2 2017 9279, Q3 2017 9694, Q4 2017 9560, Q1 2018 9935, Q2 2018 11031, Q3 2018 11877, Q4 2018 11415, Q1 2019 12113, Q2 2019 13302, Q3 2019 13952, Q4 2019 13461, Q1 2020 13720, Q2 2020 15677
Professional attendance (Physician): Q1 2016 5135, Q2 2016 5779, Q3 2016 6148, Q4 2016 5985, Q1 2017 5550, Q2 2017 5924, Q3 2017 6503, Q4 2017 6089, Q1 2018 6291, Q2 2018 7589, Q3 2018 8074, Q4 2018 7723, Q1 2019 7592, Q2 2019 8313, Q3 2019 8238, Q4 2019 7557, Q1 2020 6710, Q2 2020 6623
Professional attendance (Specialist): Q1 2016 22360, Q2 2016 23636, Q3 2016 24155, Q4 2016 23607, Q1 2017 23797, Q2 2017 24245, Q3 2017 25161, Q4 2017 24415, Q1 2018 24641, Q2 2018 26643, Q3 2018 28300, Q4 2018 28147, Q1 2019 27734, Q2 2019 28679, Q3 2019 30729, Q4 2019 29273, Q1 2020 28869, Q2 2020 27536
Professional medical - SIRA specific medical services: Q1 2016 62994, Q2 2016 66388, Q3 2016 67054, Q4 2016 63157, Q1 2017 64685, Q2 2017 65559, Q3 2017 66536, Q4 2017 62741, Q1 2018 63189, Q2 2018 63979, Q3 2018 65705, Q4 2018 61267, Q1 2019 60715, Q2 2019 60672, Q3 2019 67072, Q4 2019 62953, Q1 2020 63244, Q2 2020 67837

Increases in psychology services (+ 19%), exercise physiology (+9%) and physiotherapy (+4%), drove the increase in number of allied health services from FY2018/19 to FY2019/20.

Trends in unit cost of workers compensation healthcare services

Unit cost = average cost of services
The reduction in unit cost per service across the workers compensation scheme for the 12 months ending June 2020 was driven primarily by reductions in surgery and hospital utilisation as both have high average costs per service.
Sharp reductions in expenditure from both these groups can be seen from FY2019/20 with a significant drop seen in the last quarter of FY2019/20 which could reflect COVID restrictions.
While growth is noted in allied health services and attendance, these are lower cost services.
WC healthcare expenditure per reporting quarter

Allied health services: Q1 2016 ($26m), Q2 2016 ($29m), Q3 2016 ($30m), Q4 2016 ($29m), Q1 2017 ($31m), Q2 2017 ($32m), Q3 2017 ($35m), Q4 2017 ($35m), Q1 2018 ($37m), Q2 2018 ($43m), Q3 2018 ($46m), Q4 2018 ($45m), Q1 2019 ($47m), Q2 2019 ($50m), Q3 2019 ($54m), Q4 2019 ($50m), Q1 2020 ($50m), Q2 2020 ($51m)
Ambulance: Q1 2016 ($0.58m), Q2 2016 ($0.53m), Q3 2016 ($0.56m), Q4 2016 ($0.57m), Q1 2017 ($0.58m), Q2 2017 ($0.54m), Q3 2017 ($0.64m), Q4 2017 ($0.60m), Q1 2018 ($0.75m), Q2 2018 ($0.62m), Q3 2018 ($0.79m), Q4 2018 ($0.78m), Q1 2019 ($0.89m), Q2 2019 ($0.82m), Q3 2019 ($0.82m), Q4 2019 ($0.76m), Q1 2020 (0.70m), Q2 2020 ($0.59m)
Attendance: Q1 2016 ($29m), Q2 2016 ($231), Q3 2016 ($32m), Q4 2016 ($30m), Q1 2017 ($32m), Q2 2017 ($32m), Q3 2017 ($34m), Q4 2017 ($32m), Q1 2018 ($33m), Q2 2018 ($36m), Q3 2018 ($37m), Q4 2018 ($36m), Q1 2019 ($38m), Q2 2019 ($39m), Q3 2019 ($42m), Q4 2019 ($40m), Q1 2020 ($41m), Q2 2020 ($40m)
Care: Q1 2016 ($19m), Q2 2016 ($23m), Q3 2016 ($23m), Q4 2016 ($22m), Q1 2017 ($22m), Q2 2017 ($23m), Q3 2017 ($23m), Q4 2017 ($22m), Q1 2018 ($23m), Q2 2018 ($26m), Q3 2018 ($27m), Q4 2018 ($28m), Q1 2019 ($29m), Q2 2019 ($31m), Q3 2019 ($32m), Q4 2019 ($30m), Q1 2020 ($30m), Q2 2020 ($28m)
Dental related services: Q1 2016 ($0.69m), Q2 2016 ($0.69m), Q3 2016 ($0.76m), Q4 2016 ($0.92m), Q1 2017 ($0.83m), Q2 2017 ($0.87m), Q3 2017 ($1.0m), Q4 2017 ($1.1m), Q1 2018 ($0.88m), Q2 2018 ($1.1m), Q3 2018 ($1.0m), Q4 2018 ($1.1m), Q1 2019 ($1.0m), Q2 2019 ($1.1m), Q3 2019 ($1.2m), Q4 2019 ($1.3m), Q1 2020 ($1.1m), Q2 2020 ($0.83m)
Diagnostics: Q1 2016 ($12m), Q2 2016 ($13m), Q3 2016 ($13m), Q4 2016 ($13m), Q1 2017 ($14m), Q2 2017 ($14m), Q3 2017 ($15m), Q4 2017 ($14m), Q1 2018 ($15m), Q2 2018 ($17m), Q3 2018 ($17m), Q4 2018 ($17m), Q1 2019 ($18m), Q2 2019 ($18m), Q3 2019 ($19m), Q4 2019 ($18m), Q1 2020 ($18m), Q2 2020 ($16m)
Hospital: Q1 2016 ($30m), Q2 2016 ($34m), Q3 2016 ($40m), Q4 2016 ($38m), Q1 2017 ($37m), Q2 2017 ($39m), Q3 2017 ($44m), Q4 2017 ($44m), Q1 2018 ($39m), Q2 2018 ($38m), Q3 2018 ($56m), Q4 2018 ($47m), Q1 2019 ($53m), Q2 2019 ($55m), Q3 2019 ($54m), Q4 2019 ($52m), Q1 2020 ($49m), Q2 2020 ($36m)
Pharmaceutical services: Q1 2016 ($3.8m), Q2 2016 ($4.1m), Q3 2016 ($4.1m), Q4 2016 ($3.8m), Q1 2017 ($4.0m), Q2 2017 ($4.2m), Q3 2017 ($4.1m), Q4 2017 ($4.0m), Q1 2018 ($4.2m), Q2 2018 ($4.4m), Q3 2018 ($4.3m), Q4 2018 ($4.4m), Q1 2019 ($4.5m), Q2 2019 ($4.6m), Q3 2019 ($4.9m), Q4 2019 ($4.7m), Q1 2020 ($4.6m), Q2 2020 ($4.3m)
Refund payments: Q1 2016 ($2.8m), Q2 2016 ($3.2m), Q3 2016 ($2.6m), Q4 2016 ($3.0m), Q1 2017 ($2.3m), Q2 2017 ($2.7m), Q3 2017 ($2.3m), Q4 2017 ($2.4m), Q1 2018 ($2.1m), Q2 2018 ($2.4m), Q3 2018 ($1.9m), Q4 2018 ($2.0m), Q1 2019 ($2.1m), Q2 2019 ($2.3m), Q3 2019 ($1.9m), Q4 2019 ($1.8m), Q1 2020 ($1.7m), Q2 2020 ($1.9m)
Surgery: Q1 2016 ($28m), Q2 2016 ($31m), Q3 2016 ($34m), Q4 2016 ($32m), Q1 2017 ($33m), Q2 2017 ($36m), Q3 2017 ($39m), Q4 2017 ($39m), Q1 2018 ($38m), Q2 2018 ($43m), Q3 2018 ($46m), Q4 2018 ($43m), Q1 2019 ($44m), Q2 2019 ($46m), Q3 2019 ($47m), Q4 2019 ($46m), Q1 2020 ($43m), Q2 2020 ($33m)

Psychology and counselling – trends in number of claims accessing services and average services per claim

Claims accessing psychology services

Number of claims accessing psychology services: Q1 2016 4958, Q2 2016 5343, Q3 2016 5628, Q4 2016 5689, Q1 2017 5871, Q2 2017 6189, Q3 2017 6449, Q4 2017 6611, Q1 2018 7219, Q2 2018 8167, Q3 2018 8868, Q4 2018 9143, Q1 2019 9757, Q2 2019 10401, Q3 2019 11190, Q4 2019 11326, Q1 2020 11641, Q2 2020 11449
Average number of psychology servces per claim: Q1 2016 4.3, Q2 2016 4.4, Q3 2016 4.2, Q4 2016 4.0, Q1 2017 4.1, Q2 2017 4.1, Q3 2017 4.2, Q4 2017 4.1, Q1 2018 4.1, Q2 2018 4.4, Q3 2018 4.5, Q4 2018 4.2, Q1 2019 4.2, Q2 2019 4.3, Q3 2019 4.3, Q4 2019 4.0, Q1 2020 4.0, Q2 2020 4.8
The growth in psychology services has been driven primarily by increases in the number of claims accessing these services, rather than an increasing number of services per claim. However the latter did increase in the last quarter of FY2019/20.
Tele-psychology utilisation saw a significant rise in the last 3 months of FY2019/20 (313 to 10.65K), which offset reductions seen in face to face consultations.

Claims accessing counselling services

Number of claims accessing counselling services: Q1 2016 115, Q2 2016 120, Q3 2016 128, Q4 2016 132, Q1 2017 124, Q2 2017 146, Q3 2017 164, Q4 2017 180, Q1 2018 206, Q2 2018 228, Q3 2018 247, Q4 2018 260, Q1 2019 237, Q2 2019 276, Q3 2019 270, Q4 2019 274, Q1 2020 283, Q2 2020 314
Average number of counselling services per claim: Q1 2016 3.6, Q2 2016 4.1, Q3 2016 5.0, Q4 2016 4.0, Q1 2017 4.6, Q2 2017 4.4, Q3 2017 5.2, Q4 2017 4.5, Q1 2018 3.8, Q2 2018 3.9, Q3 2018 4.0, Q4 2018 4.1, Q1 2019 4.7, Q2 2019 4.9, Q3 2019 5.5, Q4 2019 5.2, Q1 2020 5.3, Q2 2020 6.6
The growth in counselling services have been driven by both increases in the number of claims accessing these services and the average number of services per claim.
Counselling also saw a large increase in the use of telehealth items however also showed increases in face to face consultation codes in the last 3 months of FY2019/20.

Trends in average healthcare costs per workers compensation claim

Average healthcare cost per claim continues to grow across all insurer types.

Average healthcare spend per claim

Year to June 2017: Nominal insurer $5207, TMF insurer $4148, Self insurer $3979, Specialised insurer $3608
Year to June 2018: Nominal insurer $5729, TMF insurer $4554, Self insurer $4226, Specialised insurer $2727
Year to June 2019: Nominal insurer $6261, TMF insurer $5109, Self insurer $4420, Specialised insurer $4022
Year to June 2020: Nominal insurer $6386, TMF insurer $5300, Self insurer $4543, Specialised insurer $4109

Drivers of MAIA CTP healthcare costs in the 12 months to 30 June 2020

Healthcare expenditure in the 2017 MAIA Scheme is driven primarily by increasing claims and service utilisation. Unit cost (average cost per service) has shown a slight reduction between FY2018/19 and FY2019/20 - this is possibly due to the maturing nature of the scheme, and the impact of COVID restrictions. (Refer to Appendix 1 for more information on how to interpret this chart)

Drivers of healthcare for the 12 months to 30 June 2020 in CTP

Payments for 12 months to 30 June 2020 grew by $25.9 million compared with the preceding 12 months.

During the 12-months to 30 June 2020,

Number of claims grew 17.8%.
Unit cost per service decreased 3.4%.
Service types per claim grew 11.5%.
Services per type per claim grew 9.6%.
Inflation grew by 1.29%.

The 2017 MAIA scheme continues to mature.

WC and CTP customer experience an outcomes – results of the first survey

Health-related WC and CTP findings from Regulatory Measurement of Customer Experience and Outcomes Study:

71% WC claimants rated their overall health prior to their injury (or illness) as very good or excellent. 32% rated it as very good or excellent at the time of the survey.
69% CTP claimants rated their overall health prior to their injury as very good or excellent. 22% rated it as very good or excellent at the time of the survey.
65% WC claimants and 64% CTP claimants agreed they were able to easily access the medical treatment and services they needed.
35% WC claimants and 50% CTP claimants reported that the COVID-19 situation had made it more difficult to access medical treatment and services they needed.
19% WC claimants and 25% CTP claimants were classified as having a probable serious mental illness at the time of the survey, based on their answers to specific questions developed based on Kessler 6 Psychological Distress scale, which is a six-item scale for self-reported frequency of psychological distress indicators.

Results of the first survey will form a baseline to measure future trends and inform scheme design, support recovery and return to work and activity, and regulatory supervision activities.

Appendix 1 – how to interpret the drivers of healthcare costs waterfall chart

Graph: Cost driver analysis of allied health services expenditure 12 months to 31 December 2019

Payments to 31 Dec 2018: $170m
Payments to 31 Dec 2019: $198m

During the 12-month period

Number of healthcare claims grew $9m (+5.5%).
Unit cost per service grew$4m (+2.3%).
Service types per claim grew $8m (+4.6%).
Services per service type grew $4m (+2.3%).
Inflation led to growth of $3m (+1.6%).

Change in the number of claims – Difference between the number of claims receiving any in-scope healthcare service between years. This is indicative of the propensity for claimants to access any of the in-scope medical treatments in the given year.

Change in service utilisation, comprising:

Number of different service types per claim – For a given claim, this refers to the different number of service types utilised during the year, where a service type refers to a medical sub-category. This component reflects any changes in the breadth of services accessed by claimants and the resulting expenditure impact.
Number of services provided per service type – For a given claim, this refers to the number of services that are provided to the claimant for each service type during the year (i.e. the volume of services).

Change in unit cost of each service – Differences in the average cost for each medical payment in the year. This component is impacted by many factors including service complexity, changes of the fee schedule year-on-year, and providers charging prices above the fee schedule.

Impact of inflation – Inflation is assumed to follow the Australian Consumer Price Index. This does not contribute to the levels of superimposed inflation.

Percentages shown are the impact relative to the starting payments

Glossary of terms used in this report

Days to treatment: The number of days between the when claim was first reported to the insurer (taken as date entered into system for WC and date of lodgement for CTP) and when the first service was provided to the claimant

Healthcare spend: The total amount of payments made on behalf of a claimant for healthcare related services provided in a period

Insurer Type/Group (WC only): A categorisation of the insurers in the WC scheme

Number of healthcare claims: The total number of claims with at least one healthcare related transaction in the period (i.e. during the year or in the quarter)

Number of services: Date of treatment. If this date is unknown, the transaction date is used instead

Service date: Date of treatment. If this date is unknown, the transaction date is used instead

Service type / Service sub-group: A categorisation of the type of healthcare service. Details and examples of each service types provided on the next page

Unit Cost: Average cost per service

Glossary of service types

Allied health services: Services provided by trained healthcare professionals who are not doctors, dentists or nurses e.g. physio, chiropractic, acupuncture etc.)

Example sub-groups: Chiropractic, Exercise Physiology, Physiotherapy, Psychological Services, Remedial Massage Therapy

Ambulance: Emergency related services

Example sub-groups: Ambulance

Attendance: Medical and investigation services e.g. GP services and specialist consultations

Example sub-groups: GP, Specialist

Care: Provision of personal or domestic care

Example sub-groups: Domestic, Nursing, Personal

Diagnostics: Medical imaging, including X-ray, nuclear medicine, radiation, ultrasound, MRI etc

Example sub-groups: Imaging

Hospital: Services, treatment and rehabilitation provided by private or public hospital services

Example sub-groups: Private Hospital Services, Public Hospital Services

Surgery: Any services related to surgeries including anaesthesia and assistance at operations

Example sub-groups: Anaesthesia, Specialist

Dental: Services provided by a dental practitioner

Example sub-groups: Dental and Dental Prothesis

Pharmacy: Pharmaceutical services including prescription medicines and non-prescription medicines such as analgesics and Chinese herbal medicine, as directed by a medical practitioner.

Refund payments: Includes payments to health funds for medical expenses payable under a claim and payments to Medicare Australia. Includes a payment to a worker following deduction of money owed to Medicare Australia from an advanced payment.