To identify the unit costs of services a comprehensive search of the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Google Scholar and Google was conducted. In addition specialised economic databases were reviewed and accessed through the Centre for Reviews and Dissemination allowing exposure to relevant databases including Database of Abstracts of Reviews and Effects (DARE) and 11,000 economic evaluations collected in the National Health Service Economic Evaluation Database (NHSEED). It was considered that the relevant information may also be contained within government departmental literature and as such a search was conducted of Australian Government Department websites, including: NSW Department of Health, Commonwealth Department of Health and Ageing, Veteran’s Affairs and the National Health and Medical Research Council. Where insufficient information was available a review of Department of Health websites of other Australian States was to be conducted. The NSW Injury Risk Management Research Centre and Australian Institute of Health and Welfare websites were also searched. The search was to identify cost of specified allied health and community services from 1980 to date. An exception to this rule was applied however, for certain databases such as Google Scholar and Google that yielded large results; to ensure feasibility, the search was limited from 2000 to date.

The allied health services that were investigated included: physiotherapy, occupational therapy, dietetics, podiatry, community nursing and counselling. Community services comprised of personal care, meals on wheels, transport services and domestic services including home cleaning, gardening services and general handyman rates. Staff travel was included as it is often a required cost item in economic evaluation. For international data, other allied health services were included, which appeared to be frequently utilised and had available costs reported. Respite care and estimates of family care costs were included as they were considered to be necessary cost items in economic evaluations. Excluded from the systematic review were ambulance, emergency department, time in hospital costs, medical practitioner consultations and residential care facility costs.

Included in the search terms were keywords: unit cost, unit price, schedule of fees, allied health services (range of terms of single professions and combined terms) and community services (range of terms of single services).

In addition the reference lists of retrieved articles were searched.

Included were peer-reviewed published studies or publicly available reports that included an estimate of the unit cost of services. Cost of injury studies and economic analyses associated with randomised controlled trials were included if the content included information on the unit costs of services. Whilst the predominant interest is in the range of services utilised by the “older” population, papers and reports were not excluded if the relevant information on the unit costs related to the provision of similar services to a younger population.

Although the focus of the study was on Australian costs, overseas estimates were also summarised, to complement the Australian data. International costs were converted to 2011 Australian dollars using Organisation for Economic Co-operation and Development (OECD) purchasing power parities 8 .

There was no limitation made or elimination of studies based on study quality as this factor did not impact on the accuracy of the unit costs utilised; often the information on unit costs was contained in the Appendix of relevant papers.

Direct contact with providers of domestic, gardening and handyman services in Australia was made to obtain the information on costs that was lacking in the literature. On average ten service providers were contacted from each category (full details of the providers contacted is available on request).

A standardised form was used to extract information from the published manuscripts included in the systematic review (available on request). Extracted information included: study design, cost of range of allied health and community services, source of cost item information, currency and the year of cost collection. Costs that were not relevant to the study were not incorporated. Screening of abstracts and titles and subsequent full text evaluation was conducted by IF; a sample of the manuscripts (10%) were examined by two reviewers (IF, MF). Any disagreements were resolved by consensus; where consensus was not reached, input from a third examiner was sought (CS).

The studies reported costs in different currencies and different years; this information was standardised by conversion to Australian dollars for the 2011 cost year. The process included conversion to Australian dollars, where necessary, using purchasing power parities 8 and inflation of the values to 2011 prices using the “health price index” 9 .

Studies varied in the method of reporting unit costs, some opting to describe the cost per occasion of service 10 ; whilst others describe an estimated hourly rate and others still a cost value per minute 11 . For some disciplines, such as physiotherapy and dietetics, an estimated duration was allocated to the occasion of service in some studies 6 12 . For other disciplines, such as psychological counselling services, sessions were described in terms of “simple” or “complex” interventions 13 14 .

The unit costs of different services from the various studies and government reports were extracted. In addition a conversion to a cost per hour was made, where possible, using the estimated duration of the occasion of service provided. Where a publication provided a cost per occasion of service, this was multiplied by 2.5 (session ranging in time between 20–30 minutes), providing an average of the hourly rate charged.

Overall the methodology and reporting of this study adhere to the PRISMA guidelines for conducting qualitative systematic reviews 15 .

Of the eligible studies 15 were Australian based, 18 were based in the United Kingdom, 9 based in other countries of the European Union, 3 based in the United States, 1 based in Canada, 1 based in Hong Kong and 2 were based in New Zealand.

Of the 15 Australian based studies/reports, seven (47%) were published prior to the year 2000, the first study in 1989 16 (published in 1996). Many of the Australian studies could be described as descriptive reviews and case studies (n=5), the remainder having the following study design: cost of injury studies (n=3), resource utilisation studies (n=2), economic evaluations (n=2), decision analysis modelling (n=1) and Government Department Schedule of Fees (n=2). Equal number of studies described the unit costs on an hourly basis as per session/visit basis (n=5); whereas at least four distinguished between the cost of an initial consultation and subsequent visits 3 6 10 17 . Several studies included information from local service providers and were specific to a particular environmental context 18 19 ; this affects the ability to generalise the information to an alternate setting. Others derived costs from surveys of private practitioners 6 17 20 and here the validity of the cost estimates was influenced by the size of the study.

Most of the economic evaluations retrieved from the specialised databases (n=16) were conducted in the United Kingdom (n=11, 69%); these varied in relation to the comprehensiveness of the economic evaluations conducted. Several studies tended to rely on unit costs on the established work of Curtis & Netten 21 .

Table 1 contains the unit costs of a range of allied health and community services in Australia. The calculated hourly rates for allied health services were within the range $105.67 (community nursing) to $165.77 (psychological counselling services). The results suggest considerable variety in the costs charged by private practitioners of allied health services in Australia. For all practitioners a higher fee is charged for the first consultation, than for subsequent visits. The costs charged are closely associated with the nature of the service provided and whether it is, for example, provided in the home environment or as part of a group intervention.

¹ $64.74 extended consult, $65.65 standard in institution, $76.70 extended consult (home).

²Specialist OT services (mental health) $50.95-$59.90 (20–50 minutes) $71.95-$84.60 (50 minutes +).

³$111.25 (50+ minutes- out of rooms).

⁴ $106.60 (extended).

⁵ Specialist Psych services - $57.80-$68.00 (20–50 minutes), $81.60-$96.00 (50 + minutes) Clinical Psychology- $81.60-$96.00 (30–50 minutes), $119.80-$140.90 (50+ minutes).

⁶ Out of rooms - $94.35 (20–50 minutes).

⁷ Out of rooms $122.35 (30–50 minutes), $168.15 (50+ minutes), $252.25 (90+ minutes), Neuropsychological Assessment (1–4 hours) $574.80.

⁸ Complex community nursing schedule of fees, which is dependent on the type of service provided, including: clinical mentoring, medication administration, palliative care and personal care.

⁹ Out of rooms $68.95.

¹⁰ Direct contact with service provider – meals on wheels NSW.

¹¹Direct contact with Australian Taxation Office.

¹² Direct contact with service providers (11 providers).

An average duration per occasion of service has been clarified for the disciplines of physiotherapy and dietetics 5 6 24 and is estimated to be between 20–30 minutes; but is less clear for other disciplines. Session duration appears to have an impact on the service costs 5 24 whether this is expressed in terms of the time taken per session as for physiotherapy or in the complexity of the intervention required, as for counselling 14 .

The Medicare Benefits Schedule fee is lower than the private set fee for most disciplines. The percentage discrepancy between the MBS fee and the private fee is greatest for psychological services at 59% and lowest for community nursing 80-118% (Table 1). There is indication however of flexibility in fee structure in the private setting to accommodate special populations, including clientele of the Department of Veterans’ Affairs and those supported by the Medicare Benefits Scheme.

There are other factors that impact on costing. Public hospital services, for example, are generally costed at a lower rate in comparison to private practitioner fees 18 20 . For some disciplines specialist qualifications are compensated at a higher rate by the Medicare Benefits Scheme (MBS) whereas for nursing services, cost is dependent on the complexity of services provided 24 . There has been a steady increase in the cost of service delivery for all allied health services. The percentage increase in physiotherapy being an increase of 4.00% during 2011–2012, in comparison to an increase of 2.6% during 2010-2011 27 . Most of the professional associations choose not to become involved in fee setting (Dietitians Association of Australia) but do provide members with information on average fees charged by private practitioners of their discipline (Table 1). The Australian Psychological Society produces a schedule of recommended fees for psychological services 28 .

Patient transport costs were dependent on subsidy from local or health services 20 . Domestic services, including home cleaning, gardening and handyman services are greatly influenced by the time of service delivery, with higher rates charged for work conducted on Saturday and Sunday.

Many of the studies were conducted in the United Kingdom and most utilised the reference document developed by Netten & Curtis 21 , which categorises in considerable detail the unit costs of health services. The results of the unit costs for the international data are contained in Table 2. There is variability in the costs of allied health and community services between countries, including across countries of the European Union. The work of Lafuma 29 highlights the different costs attributed to home care services between, Italy, France, Germany and The United Kingdom. International data included a wider range of reported allied health service costs with information available on the costs of social work and speech pathology. Respite care was a reported cost item in the United Kingdom, whereas estimates of the cost of family care were available for the United Kingdom and the United States. Respite care costs in the United Kingdom are highly variable and dependent on subsidy from health or local services 30 .

¹cost dependent on level of complexity of the case.

²Service is 20 minutes- $28.43 for inpatient.

³Initial consultation, $32.10 subsequent visits.

⁴ Service is 20 minutes, Home visit $111.27.

⁵Initial consultation, $87.72 subsequent visits.

⁶ 20 minute service.

⁷Clinical specialist.

⁸ $1.94 per minute (speech pathology) and $2.48 per minute (Home nursing).

⁹ Initial consultation, $87.72 subsequent visits.

¹⁰Cost is dependent on provider of service, NHS, voluntary sector or local council authority.

¹¹ $101.03 for home visit.

¹² Service is 30 minutes in duration.

¹³$101.03 for home visit.