Concerns about the Australian Institute of Health and Welfare's information on capital investment for healthcare.

Abstract

I write to draw your attention to the disparity between information published by the Australian Institute of Health and Welfare (AIHW) for 2012-131 and the Australian governments' budget allocations for that year tabulated in the article 'Investing in acute health services: is it time to change the paradigm?'.2 Indeed, the AIHW presents data on capital expenditure in a manner that obscures significant investment trends in 21st century hospitals and is misleading and unhelpful for healthcare resourcing.1It is of concern that AIHW has reduced the information on our nation's investment in health to one new line of information per year as virtually all public sector investments on hospitals, community health buildings, medical equipment, IT and communications and other capital are reduced to one number. This number does not illuminate the important questions of healthcare investment: are we investing appropriately to support Australian clinical services and is the investment sufficient for the number of patients requiring clinical care?Because there is only one line of new information published by AIHW on capital invested in healthcare it is important that it is meaningful. Table 3.4 ofHealth expenditure Australia 2012-13,1 (Capital Expenditure, by source of funds...) shows three sources of funds: those from the Australian Government, those from State, Territory and local Governments and those from the nongovernment sector. The confusion arises where all but 1.3% of funds sourced from the Australian government are included in the State, Territory and local Government figure because that is where expenditure happened. There are two consequences of this data presentation that are of concern.1First, reading the information on health expenditure in 2012-13, one would not know that, since 2009, the Commonwealth Government has made an unprecedented A$2.54 billion investment in health capital, particularly for hospitals, through the Health and Hospitals Fund (HHF). This represents a significant change in public policy on capital funding for hospitals and is worthy of note. If the AIHW decision had been to show the capital amounts by their funding source, the 2012-13 statement would have reflected the A$721.75 million allocated through the HHF as capital for healthcare projects rather than the A$72 million.Similarly, if theactual 2011-12 capital funding sourced from the Commonwealth was recorded, it would have shown an investment of A$1.218 billion by the Commonwealth for health and hospital infrastructure, rather than the A$217 milllion shown.1,3,4The second concern is that capital does not receive the detailed, careful reporting and analysis that is AIHW's usual standard. For example, confusion arises when AIHW (in Health Expenditure 2012-13) states that Commonwealth funding of health capital has had an average growth rate of -1% per annum over the decade to 2012-13.1 Yet, in Health Expenditure 2011-12,4 Commonwealth funding of health capital had an average annual growth in health capital of 14.9% over most of the same years in the decade to 2011-12. Similarly, adjustments made to annual health capital expenditure between these two health expenditure publications result in significant changes in some figures, including total capital expenditure, which varied between publications by A$767 million and A$959 million for the 4 years to 2011-12. …