Healthcare costs and outcomes in the workers compensation and CTP schemes - SIRA quarterly dashboard report

Contents of this report

This report provides analysis of healthcare costs and outcomes in the workers compensation and motor accidents insurance (CTP) schemes up to Q3 in financial year 2022 (quarter ending 31 March 2022).

The report has three sections:

• Section 1 – Summary and overall trends in quarterly healthcare costs to quarter 3, financial year 2022 (workers compensation and 2017 MAIA CTP schemes)
• Section 2 – Quarterly healthcare data update to quarter 3, financial year 2022 (Workers Compensation scheme)
• Section 3 – Drivers of healthcare expenditure for the 12 months to Quarter 3, financial year 2022 (workers compensation and 2017 MAIA CTP schemes)

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

Section 1 - Summary and overall trends in quarterly healthcare costs to quarter 3, financial year 2022 (workers compensation and 2017 MAIA CTP schemes)

Summary of key observations for Section 1

Note: Analysis is using data collected up to 30 June 2022. The data for the most recent quarters has not fully developed and will continue to mature with successive reports. Differences between successive service quarters will be impacted by seasonality of service provision and this must be taken into consideration when comparing quarter to quarter.

Workers Compensation

• Healthcare expenditure in the workers compensation scheme for Q3 of financial year (FY) 2022 totalled $235M across 88.69k claims. This represents a reduction in quarterly healthcare spend compared with the previous three quarters.
• Despite this reduction, healthcare expenditure for the 12-month period ending Q3 of FY 2022 increased by 0.85% compared with the previous 12 months.
• Allied health expenditure continued to grow despite any potential impact from the COVID-19 delta variant. For the 12 months to March 2022 allied health expenditure increased by 6.20%, driven primarily by more claims accessing allied health services and increases in the number of allied health services.

CTP (2017 MAIA scheme only)

• Healthcare expenditure in the 2017 MAIA CTP scheme for Q3 of financial year (FY) 2022 totalled $27.4M across 8.75k claims.
• Reductions in quarterly healthcare costs are seen across FY2022-Q1 (coinciding with the COVID-19 delta variant), continuing in Q2 and Q3 of FY2022.
• The reductions in quarterly healthcare costs correspond with reduced claim lodgement through those periods.
• The 2017 MAIA scheme continues to mature. It is challenging to draw conclusions on healthcare trends until the scheme reaches a steady state.
• Healthcare delivered under the 1999 MACA CTP scheme is not included in this report.

Trends in healthcare expenditure

• Healthcare expenditure for the workers compensation (WC) scheme totalled $1.04 billion for the 12 months to 31 March 2022. This represents an increase of 0.85% compared with the previous 12 months. Overall, the WC scheme demonstrates continued growth in health care expenditure despite the intermittent impacts of COVID-19. A reduction in quarterly healthcare costs is seen in FY2022-Q3. Future healthcare dashboards will help inform if this reduction is maintained in subsequent quarters.
• Healthcare expenditure for the 2017 MAIA CTP scheme totalled $126.8 million for the same 12-month period, a decrease of 3.17%. The CTP scheme demonstrates successive reductions in quarterly healthcare costs from FY2022-Q1 following the COVID-19 Delta variant. This corresponds with reduced claim lodgement through the FY2022-Q1 quarter.
• Healthcare expenditure for the 2017 MAIA CTP scheme continues to grow as the scheme matures.

WC healthcare expenditure by service quarter:

• Quarter 3 - FY2021: $260.23m
• Quarter 4 - FY2021: $278.60m
• Quarter 1 - FY2022: $261.70m
• Quarter 2 - FY2022: $264.58m
• Quarter 3 - FY2022: $235.01m

2017 MAIA CTP healthcare expenditure by service quarter:

• Quarter 3 - FY2021: $34.22m
• Quarter 4 - FY2021: $37.58m
• Quarter 1 - FY2022: $32.41m
• Quarter 2 - FY2022: $29.45m
• Quarter 3 - FY2022: $27.40m

Section 2 - Quarterly healthcare data update to Quarter 2, financial year 2022 (workers compensation scheme)

• Reductions in quarterly hospital and surgical costs are demonstrated in FY2020-Q4 and FY2022-Q1 coinciding with COVID-19 related restrictions. Increases are seen following the easing of these restrictions, more so in FY2021-Q1.
• Most other healthcare service types demonstrate a general upward trend over time, with reductions noted in FY2022-Q3, particularly for allied health and professional medical attendances. Subsequent healthcare dashboards, with additional data maturity for this reporting quarter, will assist in determining if this reduction is maintained.

WC healthcare expenditure by service type per financial year service quarter

• Allied Health Services: 2020-Q4 ($54m), 2021-Q1 ($59m), 2021-Q2 ($56m), 2021-Q3 ($57m), 2021-Q4 ($62m), 2022-Q1 ($62m), 2022-Q2 ($61m), 2022-Q3 ($55m)
• Ambulance: 2020-Q4 ($676k), 2021-Q1 ($762k), 2021-Q2 ($833k), 2021-Q3 ($902k), 2021-Q4 ($1.0m), 2022-Q1 ($925k), 2022-Q2 ($1.1m), 2022-Q3 ($1.1m)
• Attendance: 2020-Q4 ($43m), 2021-Q1 ($48m), 2021-Q2 ($46m), 2021-Q3 ($46m), 2021-Q4 ($48m), 2022-Q1 ($47m), 2022-Q2 ($45m), 2022-Q3 ($43m)
• Care services and aids: 2020-Q4 ($30m), 2021-Q1 ($34m), 2021-Q2 ($34m), 2021-Q3 ($34m), 2021-Q4 ($36m), 2022-Q1 ($35m), 2022-Q2 ($37m), 2022-Q3 ($35m)
• Dental related services: 2020-Q4 ($888k), 2021-Q1 ($993k), 2021-Q2 ($967k), 2021-Q3 ($998k), 2021-Q4 ($1.2m), 2022-Q1 ($919k), 2022-Q2 ($754k), 2022-Q3 ($952k)
• Diagnostics: 2020-Q4 ($17m), 2021-Q1 ($21m), 2021-Q2 ($20m), 2021-Q3 ($20m), 2021-Q4 ($21m), 2022-Q1 ($19m), 2022-Q2 ($19m), 2022-Q3 ($18m)
• Hospital: 2020-Q4 ($40m), 2021-Q1 ($54m), 2021-Q2 ($52m), 2021-Q3 ($49m), 2021-Q4 ($54m), 2022-Q1 ($47m), 2021-Q2 ($48m), 2022-Q3 ($38m)
• Pharmaceutical Services: 2020-Q4 ($4.9m), 2021-Q1 ($5.2m), 2021-Q2 ($5.1m), 2021-Q3 ($5.2m), 2021-Q4 ($4.9m), 2022-Q1 ($4.8m), 2022-Q2 ($4.6m), 2022-Q3 ($4.3)
• Refund payments: 2020-Q4 ($2.1m), 2021-Q1 ($1.7m), 2021-Q2 ($2.1m), 2021-Q3 ($1.5m), 2021-Q4 ($1.7m), 2022-Q1 ($1.3m), 2022-Q2 ($2.2m), 2022-Q3 ($1.2m)
• Surgery: 2020-Q4 ($36.3m), 2021-Q1 ($52.4m), 2021-Q2 ($48.5m), 2021-Q3 ($45m), 2021-Q4 ($49.8m), 2022-Q1 ($43.5m), 2022-Q2 ($45.2m), 2022-Q3 ($39.3m)

Trends in the number of workers compensation claims receiving healthcare services by insurer type

• All workers compensation insurer types demonstrated steady growth in the number of claims receiving healthcare services following the initial COVID-19 restrictions of FY2020-Q4.
• A reduction in claim numbers accessing healthcare services is seen with all insurer types in FY2022-Q1, coinciding with the COVID-19 Delta variant.
• FY2022-Q2 data, demonstrates an increase in claim numbers receiving healthcare services following the COVID-19 Delta variant.
• 2020-Q3: Nominal Insurer 54854, TMF Insurer 17319, Self Insurer 6640, Specialised Insurer 5611
• 2020-Q4: Nominal Insurer 53100, TMF Insurer 16873, Self Insurer 6477, Specialised Insurer 5041
• 2021-Q1: Nominal Insurer 57433, TMF Insurer 18267, Self Insurer 7053, Specialised Insurer 5765
• 2021-Q2: Nominal Insurer 57607, TMF Insurer 18590, Self Insurer 6928, Specialised Insurer 5868
• 2021-Q3: Nominal Insurer 58123, TMF Insurer 18921, Self Insurer 6955, Specialised Insurer 5932
• 2021-Q4: Nominal Insurer 59579, TMF Insurer 19494, Self Insurer 7256, Specialised Insurer 6131
• 2022-Q1: Nominal Insurer 57306, TMF Insurer 19272, Self Insurer 7031, Specialised Insurer 5629
• 2022-Q2: Nominal Insurer 58099, TMF Insurer 19614, Self Insurer 7037, Specialised Insurer 5691
• 2022-Q3: Nominal Insurer 56588, TMF Insurer 19669, Self Insurer 6803, Specialised Insurer 5643

The number of WC claims receiving healthcare services by service group

• Steady growth was seen in the number of claims receiving professional medical attendances and allied health following the COVID-19 impacted FY 2020-Q4. This reduced during FY 2022-Q1, likely impacted by the COVID-19 Delta variant, and, when compared with FY2021, remains at a lower relative level for Q2 and Q3 of FY 2022.
• Most other healthcare service groups also show a reduction in the number of claims receiving their services for FY 2022-Q1 (impacted by the COVID-19 Delta variant), and for the following Q2 and Q3 of FY 2022.
• Hospital and surgery, however, demonstrate slight increases in Q2-FY2022, following the easing of restrictions, and then reductions in claim numbers again for FY2022-Q3.

Number of WC claims accessing healthcare service groups by service quarter

• Steady growth was seen in the number of claims receiving professional medical attendances and allied health following the COVID-19 impacted FY 2020-Q4. This reduced during FY 2022-Q1, likely impacted by the COVID-19 Delta variant, and, when compared with FY2021, remains at a lower relative level for Q2 and Q3 of FY 2022.
• Most other healthcare service groups also show a reduction in the number of claims receiving their services for FY 2022-Q1 (impacted by the COVID-19 Delta variant), and for the following Q2 and Q3 of FY 2022.
• Hospital and surgery, however, demonstrate slight increases in Q2-FY2022, following the easing of restrictions, and then reductions in claim numbers again for FY2022-Q3.

Number of WC claims accessing healthcare service groups by service quarter

• Attendance: 2020-Q4 (69643), 2021-Q1 (775231), 2021-Q2 (76013), 2021-Q3 (77209), 2021-Q4 (78716), 2022-Q1 (76015), 2022-Q2 (76422), 2022-Q3 (75158)
• Allied Health Services: 2020-Q4 (46742), 2021-Q1 (51820), 2021-Q2 (52420), 2021-Q3 (52756), 2021-Q4 (55156), 2022-Q1 (53121), 2022-Q2 (53543), 2022-Q3 (51002)
• Care services and aids: 2020-Q4 (22602), 2021-Q1 (25787), 2021-Q2 (24884), 2021-Q3 (17822), 2021-Q4 (18320), 2022-Q1 (17323), 2022-Q2 (17699), 2022-Q3 (16909)
• Diagnostics: 2020-Q4 (17690), 2021-Q1 (21383), 2021-Q2 (20781), 2021-Q3 (20821), 2021-Q4 (21638), 2022-Q1 (19251), 2022-Q2 (19600), 2022-Q3 (18334)
• Hospital: 2020-Q4 (9054), 2021-Q1 (11902), 2021-Q2 (11542), 2021-Q3 (11279), 2021-Q4 (12064), 2022-Q1 (10200), 2022-Q2 (10885), 2022-Q3 (9369)
• Pharmaceutical Services: 2020-Q4 (19536), 2021-Q1 (21288), 2021-Q2 (20791), 2021-Q3 (21286), 2021-Q4 (21070), 2022-Q1 (19671), 2022-Q2 (18818), 2022-Q3 (17734)
• Surgery: 2020-Q4 (7004), 2021-Q1 (9146), 2021-Q2 (8614), 2021-Q3 (8072), 2021-Q4 (8595), 2022-Q1 (7829), 2022-Q2 (8232), 2022-Q3 (7314)
• Ambulance:  2020-Q4 (865), 2021-Q1 (890), 2021-Q2 (1108), 2021-Q3 (1223), 2021-Q4 (1152),  2022-Q1 (968), 2022-Q2 (1118), 2022-Q3 (998)
• Refund payments: 2020-Q4 (596), 2021-Q1 (622), 2021-Q2 (555), 2021-Q3 (449), 2021-Q4 (343), 2022-Q1 (279), 2022-Q2 (237), 2022-Q3 (237)
• Dental related services: 2020-Q4 (417), 2021-Q1 (482), 2021-Q2 (479), 2021-Q3 (505), 2021-Q4 (540), 2022-Q1 (404), 2022-Q2 (438), 2022-Q3 (448)

Trends in the number of healthcare services by service group for workers compensation claims

• The number of healthcare services shows a reduction across most healthcare service groups for FY2022 Q2 and Q3, with Care services and aids the exception.
• The recent reductions are most noted with allied health services and professional attendances. An analysis of service sub-groups informs the drivers of these reductions is related to physiotherapy services and general practitioner professional attendances.
• Hospital, surgery, and diagnostics demonstrate very similar trends in the numbers of services per quarter, all impacted by COVID related restrictions, but recovering and remaining relatively static thereafter.

Number of services by service group in WC

• Allied Health Services: 2020-Q4 (449973), 2021-Q1 (497219), 2021-Q2 (468008), 2021-Q3 (490728), 2021-Q4 (521685), 2022-Q1 (526381), 2020-Q2 (503496), 2022-Q3 (458759)
• Ambulance: 2020-Q4 (1198), 2021-Q1 (1136), 2021-Q2 (1465), 2021-Q3 (1715), 2021-Q4 (1663), 2022-Q1 (1353), 2022-Q2 (1526), 2022-Q3 (1326)
• Attendance: 2020-Q4 (326971), 2021-Q1 (365425), 2021-Q2 (348574), 2021-Q3 (350257), 2021-Q4 (359378), 2022-Q1 (356237), 2022-Q2 (343019), 2022-Q3 (321676)
• Care services and aids: 2020-Q4 (98427), 2021-Q1 (112166), 2021-Q2 (111976), 2021-Q3 (92995), 2021-Q4 (97320), 2022-Q1 (88284), 2022-Q2 (96200), 2022-Q3 (89715)
• Dental related services: 2020-Q4 (1612), 2021-Q1 (1878), 2021-Q2 (1785), 2021-Q3 (1965), 2021-Q4 (1992), 2022-Q1 (1513), 2022-Q2 (1521), 2022-Q3 (1759)
• Diagnostics: 2020-Q4 (45111), 2021-Q1 (56871), 2021-Q2 (52677), 2021-Q3 (51818), 2021-Q4 (55354), 2022-Q1 (48815), 2022-Q2 (48065), 2022-Q3 (41910)
• Hospital: 2020-Q4 (42245), 2021-Q1 (56500), 2021-Q2 (52470), 2021-Q3 (49362), 2021-Q4 (55311), 2022-Q1 (46333),2022-Q2 (44230), 2022-Q3 (34027)
• Pharmaceutical Services: 2020-Q4 (123223), 2021-Q1 (130535), 2021-Q2 (126498), 2021-Q3 (129750), 2021-Q4 (137174), 2022-Q1 (136147), 2022-Q2 (128203), 2022-Q3 (120240)
• Refund payments: 2020-Q4 (719), 2021-Q1 (759), 2021-Q2 (692), 2021-Q3 (563), 2021-Q4 (412),  2022-Q1 (332), 2022-Q2 (389), 2022-Q3 (268)
• Surgery: 2020-Q4 (39633), 2021-Q1 (55767), 2021-Q2 (49438), 2021-Q3 (44058), 2021-Q4 (47828), 2022-Q1 (42138), 2022-Q2 (44213), 2022-Q3 (38359)

Trends in the number of services by service sub-group for workers compensation claims

• Physiotherapy, having been the prominent driver of increased allied health utilisation previously, demonstrates reductions in the number of services for FY2022 Q2 and Q3.
• General practitioner (GP) attendances demonstrate a reduction in number of services for FY2022 Q2 and Q3 after previously being the main driver of professional attendance utilisation.

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

• Claims accessing psychological services continues to grow. The average number of services per claim per quarter demonstrates an increase during both COVID-19 impacted quarters but has remained relatively steady otherwise.
• Claims accessing counselling services on a quarterly basis has continued to grow in recent quarters.

Claims accessing psychology services

• Number of claims accessing psychology services: 2020-Q4 (12014), 2021-Q1 (12665), 2021-Q2 (12727), 2021-Q3 (13190), 2021-Q4 (13898), 2022-Q1 (14184), 2022-Q2 (14073), 2022-Q3 (13720)
• Average Psychology services per claim: 2020-Q4 (4.83), 2021-Q1 (4.50), 2021-Q2 (4.18), 2021-Q3 (4.05), 2021-Q4 (4.17), 2022-Q1 (4.58), 2022-Q2 (4.28), 2022-Q3 (4.03)

Claims accessing counselling services

• Number of claims accessing counselling services: 2020-Q4 (335), 2021-Q1 (376), 2021-Q2 (376),   2021-Q3 (451), 2021-Q4 (544), 2022-Q1 (567), 2022-Q2 (672), 2022-Q3 (655),
• Average Counselling services per claim: 2020-Q4 (6.75), 2021-Q1 (5.20), 2021-Q2 (5.05), 2021-Q3 (4.63), 2021-Q4 (4.80), 2022-Q1 (5.45), 2022-Q2 (4.60), 2022-Q3 (4.19)

Average cost of healthcare per claim in the workers compensation scheme by insurer type

• A spike in average healthcare cost per claim is seen in FY2021-Q1, most likely a result of access to postponed higher cost healthcare such as surgery and hospital services.
• Trends in average healthcare costs per claim per financial quarter are varied across all insurers following this spike. However, a higher average cost appears to be maintained in the quarters leading to FY2022-Q1.
• Following FY2022-Q1 (impacted by the COVID-19 Delta variant) all insurers demonstrate an overall reduction in average healthcare cost per claim. Data maturity with subsequent healthcare dashboards will help understand if this reduction will be maintained.
• No adjustment for case mix has been made for these figures.

Average healthcare cost (nominal) per claim by insurer type

• Financial quarter 2020-Q3: Nominal Insurer ($3,239), TMF Insurer ($2,290), Self Insurer ($2,420), Specialised Insurer ($2,216)
• Financial quarter 2020-Q4: Nominal Insurer ($3,076), TMF Insurer ($2,319), Self Insurer ($2,295), Specialised Insurer ($2,270)
• Financial quarter 2021-Q1: Nominal Insurer ($3,378), TMF Insurer ($2,555), Self Insurer ($2,898), Specialised Insurer ($2,610)
• Financial quarter 2021-Q2: Nominal Insurer ($3,289), TMF Insurer ($2,416), Self Insurer ($2,496), Specialised Insurer ($2,436)
• Financial quarter 2021-Q3: Nominal Insurer ($3,167), TMF Insurer ($2,313), Self Insurer ($2,558), Specialised Insurer ($2,466)
• Financial quarter 2021-Q4: Nominal Insurer ($3,290), TMF Insurer ($2,474), Self Insurer (2,586), Specialised Insurer ($2,549)
• Financial quarter 2022-Q1: Nominal Insurer ($3,202), TMF Insurer ($2,390), Self Insurer ($2,576), Specialised Insurer ($2,492)
• Financial quarter 2022-Q2: Nominal Insurer ($3,220), TMF Insurer ($2,375), Self Insurer ($2,423), Specialised Insurer ($2,440)
• Financial quarter 2022-Q3: Nominal Insurer ($2,913), TMF Insurer ($2,118), Self Insurer ($2,361), Specialised Insurer ($2,211)

Average number of healthcare services per claim in the workers compensation scheme by insurer type

• The average number of healthcare services per claim increased gradually across all insurers from FY2017-Q3 to FY2018-Q4.
• Since this appears to have flattened to a new higher average number of healthcare services per claim per quarter, with some minor seasonal variations.
• An further increase is seen in the average number of healthcare services per claim in FY2021-Q1 (most likely attributed to easing of COVID-19 restrictions, allowing access to postponed services).
• For the 6 months following FY2022-Q1 (COVID-19 Delta variant) average number of healthcare services per claim has reduced across all insurers. Subsequent healthcare quarterly dashboard reports will demonstrate if this reduction is maintained.
• No adjustment for case mix has been made in this graph.

Average number of healthcare services per claim by insurer type

• Financial quarter 2020-Q3: Nominal Insurer (14.6), Self Insurer (11.6), Specialised Insurer (10.1), TMF Insurer (12.1)
• Financial quarter 2020-Q4: Nominal Insurer (14.8), Self Insurer (11.8), Specialised Insurer (10.7), MF Insurer (12.7)
• Financial quarter 2021-Q1: Nominal Insurer (15.4), Self Insurer (12.8), Specialised Insurer (10.8), TMF Insurer (13.2)
• Financial quarter 2021-Q2: Nominal Insurer (14.6), Self Insurer (11.9), Specialised Insurer (10.3), TMF Insurer (12.2)
• Financial quarter 2021-Q3: Nominal Insurer (14.5), Self Insurer (12.2), Specialised Insurer (10.5), TMF Insurer (11.9)
• Financial quarter 2021-Q4: Nominal Insurer (14.8), Self Insurer (12.2), Specialised Insurer (10.9), TMF Insurer (12.4)
• Financial quarter 2022-Q1: Nominal Insurer (14.8), Self Insurer (12.4), Specialised Insurer (11.4), TMF Insurer (12.8)
• Financial quarter 2022-Q2: Nominal Insurer (14.2), Self Insurer (11.8), Specialised Insurer (10.6), TMF Insurer (12.3)
• Financial quarter 2022-Q3: Nominal Insurer (13.4), Self Insurer (10.9), Specialised Insurer (9.8), TMF Insurer (11.3)

Section 3 - Drivers of healthcare expenditure for the 12 months to 31 March 2022

The following graphs provide analysis of cost drivers in healthcare over the twelve-month period from 1 April 2021 to 31 March 2022 compared to the period 1 April 2020 to 31 March 2021. This is not a comparison of financial years.

The cost driver analysis apportions the change in total healthcare expenditure between the consecutive periods to:

• Change in healthcare claims (across all service types)
• Number of different healthcare service types per claim
• Number of healthcare services per healthcare service type
• Change in the average cost of each healthcare service
• Impact of inflation

Consideration must be made when comparing the following graphs to drivers of healthcare expenditure graphs in previous reports as they may cover overlapping time periods.

Drivers of workers compensation healthcare expenditure for the 12 months to March 2022

Healthcare expenditure in the workers compensation scheme grew 0.85% in the 12 months to March 2022 compared with the previous 12 month period. This has been driven primarily by increases in the number of services per healthcare service type, the number of claims accessing in-scope healthcare services, and inflationary change. The service types per claim and the average cost per healthcare service were negative drivers for the 12 month period.  (See Appendix 1 for more information on how to interpret this chart).

• Payments to March 2021: $1,031.2 million
• Payments to March 2022 $1,039.9 million

During the 12-month period up to 31 March 2022, the number of claims, the number of services per service type, and inflation contributed to additional expenditure of 1.72%, 3.01%, and 3.70% respectively. The number of service types per claim and average cost per service had negative contributions to overall expenditure with respective decreases of 4.56%, and 3.03%.

Drivers of workers compensation healthcare costs for the last three years ending 31 March 2022

• 12 months to Mar 2020 – all drivers of healthcare expenditure contributed to positive growth when compared with the previous 12-month period, except for the average cost per service. Of the drivers of positive healthcare growth the number of claims, and service utilisation (comprising of the number of service types per claim and the number of services per service type) were the main contributors.
• 12 months to Mar 2021 – the main driver was utilisation (number of service types per claim and the number of services per service type). The number of claims was a small negative driver. Average cost per service was a significant negative driver, reflecting the potential impact of the reductions in high-cost services of hospital and surgery due to COVID-19.
• 12 months to Mar 2022 – the number of claims has returned as a positive driver of growth in healthcare expenditure. While the number of service types per claim was a negative driver, the number of services per service type remained as a strong positive driver. Average cost per service was still a strong negative driver, reflecting the potential impact of reductions in high-cost services of hospital and surgery due to the COVID-19 Delta variant.
• Inflation continues to contribute to healthcare expenditure growth across all periods, more notably in the 12 months to March 2022.

Changes in growth of workers compensation healthcare expenditure

• Number of claims: March 2020 $36.1m; March 2021 -$2.0m; March 2022 $17.7m
• Service types per claim: March 2020 $19.1m; March 2021 $4.1m; March 2022 -$47.0m
• Services per service type: March 2020 $26.1m; March 2021 $38.0m; March 2022 $31.1m
• Average cost per service: March 2020 -$4.1m; March 2021 $19.7m; March 2022 $31.3m
• Inflation: March 2020 $16.4m; March 2021 $6.4m; March 2022 $38.2m

Drivers of 2017 MAIA CTP scheme healthcare expenditure for the 12 months to 31 March 2022

Healthcare expenditure in the 2017 MAIA CTP scheme decreased by 3.17% in the 12 months to March 2022 compared with the previous 12 month period. This has been driven by decreases in the number of services per healthcare service type, number of services per claim and the average cost per healthcare service. The number of claims accessing in-scope healthcare services and inflationary change were positive drivers for the 12 month period.

Payments for 12 months to 31 March 2022 decreased by $4.15 million compared with the preceding 12 months.

During the 12-months to 31 March 2022;

• Number of claims grew 1.29%.
• Service types per claim decreased by 1.75%.
• Services per service type decreased by 0.36%.
• Average cost per service decreased by 5.56%.
• Inflation grew by 3.21%.

The 2017 MAIA scheme continues to mature.

Drivers of 2017 MAIA CTP scheme healthcare expenditure for the last two years ending 31 March 2022

• 12 months to Mar 2021 – all drivers of healthcare expenditure in the CTP scheme contributed to positive growth for the 12 months to March 2021, particularly the number of claims, and service utilisation (comprising of the number of service types per claim and the number of services per service type).
• 12 months to Mar 2022 – the number of claims and inflation contributed to positive growth in healthcare expenditure for the 12 months ending March 2022. All other drivers represented negative growth, particularly average cost per service, potentially reflecting the impact of reductions in high-cost services of hospital and surgery due to the impacts of COVID-19.

Changes in the growth of CTP healthcare expenditure

• Number of claims: March 2021 $5.8m; March 2022 $1.7m
• Service types per claim: March 2021 $5.0m; March 2022 -$2.3m
• Services per service type: March 2021 $8.4m; March 2022 -$472k
• Average cost per service: March 2021 $1.6m; March 2022 -$7.3m
• Inflation: March 2021 $681k; March 2022 $4.2m

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

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 average 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 cost of payments made on behalf of a claimant for healthcare related services provided in a period. All figures are nominal unless specified otherwise.

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

SIRA specific medical services: A set of payment codes developed by SIRA for specific medical services in addition to services found in the AMA Fees List and relevant to NSW personal injury schemes. SIRA specific services includes SIRA certificate of capacity, report writing and case conferencing, among others.

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

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.