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Episode of care—source of funding, patient funding source code NN

Data Element Attributes

Identifying and definitional attributes

Metadata item type:Help on this termData Element
Short name:Help on this termFunding source for hospital patient
METEOR identifier:Help on this term472033
Registration status:Help on this term

Health, Superseded 07/03/2014

Definition:Help on this termThe source of funds for an admitted patient episode or non-admitted patient service event, as represented by a code.
Context:Help on this term

Admitted patient care.

Hospital non-admitted patient care.

Data Element Concept:Help on this termEpisode of care—source of funding
Value Domain:Help on this termPatient funding source code NN

Value domain attributes

Representational attributes

Representation class:Help on this termCode
Data type:Help on this termString
Format:Help on this termNN
Maximum character length:Help on this term2
  ValueMeaning
Permissible values:Help on this term01Health service budget (not covered elsewhere)
  02Health service budget (due to eligibility for Reciprocal Health Care Agreement)
  03Health service budget (no charge raised due to hospital decision)
  04Department of Veterans' Affairs
  05Department of Defence
  06Correctional facility
  07Medicare Benefits Scheme
  08Other hospital or public authority (contracted care)
  09Private health insurance
  10Worker's compensation
  11Motor vehicle third party personal claim
  12Other compensation (e.g. public liability, common law, medical negligence)
  13Self-funded
  88Other funding source
Supplementary values:Help on this term98
 
Not known
 

Collection and usage attributes

Guide for use:Help on this term

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.

CODE 02   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 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 03   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.

CODE 07   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.

CODE 08   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 09   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 09, regardless of whether it is the majority source of funds.

Excludes: Overseas visitors for whom travel insurance is the major funding source.

CODE 13   Self-funded

This code includes funded by the patient, by the patient's family or friends, or by other benefactors.

CODE 88   Other funding source

This code includes overseas visitors for whom travel insurance is the major funding source.

Comments:Help on this term

Users should note that this value domain reuses codes from the two value domains it supersedes, e.g. Code 03 in the superseded value domain, Hospital patient funding source code NN, = 'Self-funded', whereas Code 03 in this value domain, Patient funding source code NN, = 'Health service budget (no charge raised due to hospital decision)'. Code 03 in the superseded value domain has the same meaning as Code 13, 'Self-funded', in this value domain.

Similarly, Code 14 in the superseded value domain, Non-admitted patient funding source code NN, = 'Other funding' has the same meaning as Code 88, 'Other funding', in this value domain.

Users should take care when interpreting data and metadata based on these value domains.

Data element attributes Help on this term

Collection and usage attributes

Guide for use:Help on this term

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.

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.

Relational attributes

Related metadata references:Help on this term
Supersedes Episode of care—principal source of funding, hospital code NN

        Health, Superseded 11/04/2012

Supersedes Non-admitted patient service event—principal source of funding, code NN

        Health, Superseded 11/04/2012

        Independent Hospital Pricing Authority, Standard 01/11/2012

Has been superseded by Episode of care—source of funding, patient funding source code NN

        Health, Superseded 05/10/2016

See also Appointment—principal source of funding, patient funding source code AAA

        WA Health, Standard 19/03/2015

See also Appointment—principal source of funding, patient funding source code AAA

        WA Health, Standard 24/04/2015

Implementation in Data Set Specifications:Help on this term
All attributes +
Admitted patient care NMDS 2012-13

        Health, Superseded 02/05/2013

DSS specific attributes +
Implementation start date: 01/07/2012
Implementation end date: 30/06/2013

Admitted patient care NMDS 2013-14

        Health, Superseded 11/04/2014

DSS specific attributes +
Implementation start date: 01/07/2013
Implementation end date: 30/06/2014

Non-admitted patient DSS 2013-14

        Health, Superseded 07/03/2014

DSS specific attributes +
Implementation start date: 01/07/2013
Implementation end date: 30/06/2014

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