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The Pricing Framework 2016-17 builds on the Pricing Frameworks from previous years (2012-13, 2013-14, 2014-15 and 2015-16). For simplicity, where IHPA has reaffirmed a previous principle, the supporting argument has not been restated in this year’s paper.
The Independent Hospital Pricing Authority (Pricing Authority) is established under the National Health Reform Act 2011 (Cth) (the Act), and by virtue of section 131(1) of the Act is invested with the following functions relevant to this National Efficient Price (NEP) Determination 2016 (Determination):
ICD-10-AM/ACHI/ACS Eighth Edition was implemented between 1 July 2013 and 30 June 2015 for classifying episodes of admitted patient care across Australian hospital services.
The ICD-10-AM/ACHI/ACS classification system is comprised of the following classifications:
The Australian Refined Diagnosis Related Group (AR-DRG) Version 7.0 was implemented from July 1, 2014 and is the Australian Diagnosis Related Group (DRG) patient classification system that provides a clinically meaningful way of relating the types of patients treated in the hospital to the resources required by the hospital. AR-DRGs incorporate the ICD-10-AM/ACHI/ACS.
The AR-DRG Version 7.0 is published as a set of three Definition Manuals described below.
In June 2012, the Independent Hospital Pricing Authority (IHPA) published the National Efficient Price Determination for 2012-13, and the Pricing Framework for Australian Public Hospital Services 2012- 2013 that underpinned the determination. In September 2012, IHPA released a consultation paper on key issues that IHPA was considering in the preparation of the Pricing Framework for Australian Public Hospital Services 2013-2014.
The Independent Hospital Pricing Authority (Pricing Authority) is established under the National Health Reform Act 2011 (Cth) (the Act), and by virtue of section 131(1) of the Act is invested with the following functions relevant to this National Efficient Price Determination 2013 (Determination):
(a) to determine the national efficient price for health care services provided by public hospitals where the services are funded on an activity basis;