OBJECTIVES: Australia (population 24.6 million) has a mixed public-private health care system: over 50% of hospital beds belong to state-run ‘public’ hospitals (care that is free) but over 50% of elective procedures are performed in private hospitals, subsidized by both the government and private health insurance (PHI; held by approximately 50% of the population). We applied a uniform method for measuring low-value care (LVC) in public hospitals (27 procedures) and private hospitals (21 procedures) across multiple Australian jurisdictions and payers.

METHODS: Analysis of admitted patient data for one year (2014-15) for multiple states (covering all hospitals in each state) representing 17.6 million Australians (71.5% of the population). The PHI analyses covered all members from multiple insurers representing 67.5% of privately insured Australians. We measured prevalence, costs, payer and hospital variation of LVC by two definitions (narrow and broad).

RESULTS: Between states (public hospitals), for all 27 procedures combined the LVC percent ranged from 9.4-11.1% (narrow definition) and 17.4-19.2% (broad). Across private insurers, LVC ranged from 19.4-30.3% (narrow) and 29.4-37.8% (broad) for all 21 services. Both sectors revealed wide hospital-level variation. Total LV direct costs for this small sample of services in one year was AUD225 million (narrow) to AUD475 million (broad).

CONCLUSIONS: A uniform method for measuring LVC across the system – as applied here – elucidates the scale of the problem, what is driving LVC, and of remedial possibilities. Australia is federated with semi-autonomous states much like the US. The level of coordination and cooperation shown here offers insights as to how local payers/jurisdictions can join forces towards a national quality agenda. As well as methods and results, insights will be offered as to how this coordinated project was established, where it will go in terms of joint learning, LVC remedial activities, and related formal evaluations.