Culturally and Linguistically Diverse Patient Costing Study

1Consultation Findings

All jurisdictions, with the exception of the Australian Capital Territory participated in this review. Key findings from these consultations are summarised in the table below.

204Table 4.0.1: Summary of consultation findings

Jurisdiction	Primary CALD indicators	Cost drivers	Cost allocation methodology
Victoria	Interpreter required, Interpreter booked, LEP	Interpreter cost	Interpreter utilisation data, allied health intervention codes
South Australia	Interpreter required, Main language spoken at home	Interpreter cost	Interpreter utilisation data (acute patients only)
New South Wales	Preferred language, Interpreter required	Interpreter cost, longer health practitioner or consultation time	Allocated as an overhead expense to all patients
Queensland	Interpreter required, Interpreter booked, Language spoken at home	Interpreter cost, additional administration and communication cost	Allocated as an overhead expense to all patients
Western Australia	Country of birth, preferred language	Interpreter cost	Allocated as an overhead expense to all patients
Northern Territory	Country of birth, Interpreter required	Interpreter cost	No specific allocation method is used
Tasmania	Interpreter required, first spoken language	Interpreter cost	Allocated as an overhead expense to all patients

During consultations for this review, majority of the stakeholders indicated that CALD specific costs are currently not distinctly allocated to CALD patient episodes, instead the costs are allocated to a wider range of CALD and non CALD patients across all product types. Key findings from these consultations are described below.

1.1Victoria

1.1.1Identification of CALD patients

205Four Victorian Local Health Networks (Southern Health, Northern Health, Eastern Health and Western Health) were nominated for the consultations and review of CALD indicators and cost allocation methods applied for CALD specific costs in Victoria.

206Northern Health and other sites in Victoria indicated that the following CALD related measures are useful in identifying the patient groups that require extra resources within a hospital.

207• Low English Proficiency (LEP)

208• Interpreter Required

209• Interpreter Booked

210• Socio Economic Status

211• Refugee status

212• Year of arrival to Australia

213Religion, Country of Birth, NESB (non-English speaking background) and Language Spoken at Home were not seen as useful indicators for this population.

214It was noted that the most reliable indicator was the ‘interpreter required’ flag which is recorded against individual patient records. The ‘interpreter required’ flag which is supplied to the Department (Victorian Cost Data Collection) is seen as being reliable and accurate.

‘Interpreter booked’ field is also considered a key CALD indicator and believed to be a better indicator of actual utilisation if this is available from the hospital PAS systems.

1.1.1Patient cost drivers

215Interpreter cost is noted as the primary cost for this population of patients. It is noted that external interpreter costs are much higher in comparison and low use languages (emerging or obscure) are more expensive than high use languages.

216There are two dimensions that are seen to be impacting on cost at the nominated Victorian sites, the level of health literacy of the patients and the level of English proficiency which produces barriers to effective communication. Some other key themes which impact on the cost of the patients within the hospital are access to GPs, refugee referrals within the acute phase of migration and socio economic status in this population.

217A number of studies have been performed on the LOS within this patient population. Northern Health also analysed the impact of interpreter use on LOS and observed that there was a positive influence on LOS in patients that received interpreters versus those who required interpreters but did not receive them.

218Age was not considered to be a major differentiator of cost within this population. The Year of Arrival in Australia was considered to be a more important indicator than age.

219The group was not aware of any significant analysis done into re-admission rates or disease profiles within this population.

1.1.1Cost allocation methods

220At a number of Victorian sites (Southern Health and St Vincent’s) the interpreter utilisation is stated to be applied to the patient episodes. At Northern Health relevant expenditure is isolated to the Translation and Linguistic Services cost centres. These costs are allocated using the number of interpreters and utilisation data from an interpreter feeder as cost drivers.

221Eastern Health uses allied health intervention codes to allocate interpreter costs. It is a flat distribution based on the number of codes reported.