The source of funding should be assigned based on a best estimate of where the majority of funds come from, except for private health insurance, which should be assigned wherever there is a private health insurance contribution to the cost. This data element is not designed to capture information on out-of-pocket expenses to patients (for example, fees only partly covered by the Medicare Benefits Schedule).
If a charge is raised for accommodation or facility fees for the episode/service event, the intent of this data element is to collect information on who is expected to pay, provided that the charge would cover most of the expenditure that would be estimated for the episode/service event. If the charge raised would cover less than half of the expenditure, then the funding source that represents the majority of the expenditure should be reported (excludes code 02 Private health insurance, see below).
If there is an expected funding source followed by a finalised actual funding source (for example, in relation to compensation claims), then the actual funding source known at the end of the reporting period should be recorded.
The expected funding source should be reported if the fee has not been paid but is not to be waived.
The major source of funding should be reported for nursing-home type patients.
Code 01 Health service budget (not covered elsewhere)
Health service budget (not covered elsewhere) should be recorded as the funding source for Medicare eligible patients for whom there is no other funding arrangement.
Excludes: Inter-hospital contracted patients and overseas visitors who are covered by Reciprocal health care agreements and elect to be treated as public admitted patients.
Code 02 Private health insurance
Patients who are funded by private health insurance, including travel insurance for Medicare eligible patients. If patients receive any funding from private health insurance, choose Code 02, regardless of whether it is the majority source of funds.
Excludes: Overseas visitors for whom travel insurance is the major funding source.
Code 03 Self funded
This code includes funded by the patient, by the patient's family or friends, or by other benefactors.
Code 10 Other hospital or public authority (contracted care)
Patients receiving treatment under contracted arrangements with another hospital (inter-hospital contracted patient) or a public authority (e.g. a state or territory government).
Code 11 Health service budget (due to eligibility for Reciprocal Health Care Agreement)
Patients who are overseas visitors from countries covered by Reciprocal Health Care Agreements.
Australia has Reciprocal Health Care Agreements with the United Kingdom, the Netherlands, Italy, Malta, Sweden, Finland, Norway, Belgium, Slovenia, New Zealand and Ireland. The Agreements provide for free accommodation and treatment as a public patient in public hospital services, but do not cover treatment as a private patient in any kind of hospital.
The Agreements with Finland, Italy, Malta, the Netherlands, Norway, Sweden, Belgium, Slovenia and the United Kingdom provide free care as a public patient in public hospitals, subsidised out-of-hospital medical treatment under Medicare, and subsidised medicines under the Pharmaceutical Benefits Scheme.
The Agreements with New Zealand and Ireland provide free care as a public patient in public hospitals and subsidised medicines under the Pharmaceutical Benefits Scheme, but do not cover out-of-hospital medical treatment.
Visitors from Italy and Malta are covered for a period of six months from the date of arrival in Australia only.
Visitors from Belgium, the Netherlands and Slovenia require their European Health Insurance card to enrol in Medicare. They are eligible for treatment in public hospitals until the expiry date indicated on the card, or to the length of their authorised stay in Australia if earlier.
Excludes: Overseas visitors who elect to be treated as private patients or under travel insurance.
Code 12 Other funding source
This code includes overseas visitors for whom travel insurance is the major funding source.
Code 13 Health service budget (no charge raised due to hospital decision)
Patients who are Medicare ineligible and receive public hospital services free of charge at the discretion of the hospital or the state/territory. Also includes patients who receive private hospital services for whom no accommodation or facility charge is raised (for example, when the only charges are for medical services bulk-billed to Medicare), and patients for whom a charge is raised but is subsequently waived.
- Admitted public patients (Medicare eligible) whose funding source should be recorded as Health service budget (not covered elsewhere) or Health service budget (due to eligibility for Reciprocal Health Care Agreements).
- Medicare eligible non-admitted patients, presenting to a public hospital emergency department and Medicare eligible patients (for whom there is not a third party payment arrangement) presenting at a public hospital outpatient department, whose funding source should be recorded as Health service budget (not covered elsewhere).
- Patients presenting to an outpatient department who have chosen to be treated as a private patient and have been referred to a named medical specialist who is exercising a right of private practice. These patients are not considered to be patients of the hospital.
Code 14 Medicare Benefits Scheme
Medicare eligible patients presenting at a public hospital for whom services are billed to Medicare. Includes both bulk-billed patients and patients with out-of-pocket expenses. This value is not applicable for admitted patients.