{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T21:17:47Z","timestamp":1789161467007,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T00:00:00Z","timestamp":1689897600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2023,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate elective rates of spinal fusion, decompression, and disc replacement procedures for people with degenerative conditions, by funding type (public, private, workers\u2019 compensation).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, setting<\/jats:title><jats:p>Cross\u2010sectional study; analysis of hospitals admissions data extracted from the New South Wales Admitted Patient Data Collection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All adults who underwent elective spinal surgery (spinal fusion, decompression, disc replacement) in NSW, 1 July 2001 \u2013 30 June 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Crude and age\u2010 and sex\u2010adjusted procedure rates, by procedure, funding type, and year; annual change in rates, 2001\u201320, expressed as incidence rate ratios (IRRs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During 2001\u201320, 155\u2009088 procedures in 129\u2009525 adults were eligible for our analysis: 53\u2009606 fusion, 100\u2009225 decompression, and 1257 disc replacement procedures. The privately funded fusion procedure rate increased from 26.6 to 109.5 per 100\u2009000 insured adults (per year: IRR, 1.06; 95% confidence interval [CI], 1.05\u20131.07); the workers\u2019 compensation procedure rate increased from 6.1 to 15.8 per 100\u2009000 covered adults (IRR, 1.04; 95% CI, 1.01\u20131.06); the publicly funded procedure rate increased from 5.6 to 12.4 per 100\u2009000 adults (IRR, 1.03; 95% CI, 1.01\u20131.06), and from 10.5 to 22.1 per 100\u2009000 adults without hospital cover private health insurance (IRR, 1.03; 95% CI, 1.01\u20131.05). The privately funded decompression procedure rate increased from 93.4 to 153.6 per 100\u2009000 people (IRR, 1.02; 95% CI, 1.01\u20131.03); the workers\u2019 compensation procedure rate declined from 19.7 to 16.7 per 100\u2009000 people (IRR, 0.98; 95% CI, 0.96\u20130.99), and the publicly funded procedure rate did not change significantly. The privately funded disc replacement procedure rate increased from 6.2 per million in 2010\u201311 to 38.4 per million people in 2019\u201320, but did not significantly change for the other two funding groups. The age\u2010 and sex\u2010adjusted rates for privately and publicly funded fusion and decompression procedures were similar to the crude rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Privately funded spinal surgery rates continue to be larger than for publicly funded procedures, and they have also increased more rapidly. These differences may indicate that some privately funded procedures are unnecessary, or that the number of publicly funded procedures does not reflect clinical need.<\/jats:p><\/jats:sec>","DOI":"10.5694\/mja2.52046","type":"journal-article","created":{"date-parts":[[2023,7,21]],"date-time":"2023-07-21T08:36:09Z","timestamp":1689928569000},"page":"303-309","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Elective spinal surgery in New South Wales adults, 2001\u201320, by procedure funding type: a cross\u2010sectional study"],"prefix":"10.5694","volume":"219","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1454-9462","authenticated-orcid":false,"given":"Duong Thuy","family":"Tran","sequence":"first","affiliation":[{"name":"Centre for Big Data Research in Health the University of New South Wales  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6258-3692","authenticated-orcid":false,"given":"Adriane M","family":"Lewin","sequence":"additional","affiliation":[{"name":"The University of New South Wales  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Jorm","sequence":"additional","affiliation":[{"name":"Centre for Big Data Research in Health the University of New South Wales  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0887-7627","authenticated-orcid":false,"given":"Ian A","family":"Harris","sequence":"additional","affiliation":[{"name":"Centre for Big Data Research in Health the University of New South Wales  Sydney NSW"},{"name":"Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"e_1_2_8_1_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06900-8"},{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13013-017-0121-3"},{"key":"e_1_2_8_3_1","volume-title":"The fourth Australian atlas of healthcare variation","author":"Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare","year":"2021"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51788"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-028743"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000002822"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2020.1839244"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-009011"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-2197.2009.05095.x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001869"},{"key":"e_1_2_8_11_1","unstructured":"State Insurance Regulatory Agency (NSW).Workers compensation insurance.https:\/\/www.sira.nsw.gov.au\/insurance\u2010coverage\/workers\u2010compensation\u2010insurance(viewed Aug 2022)."},{"key":"e_1_2_8_12_1","unstructured":"Medical Services Advisory Committee.Application 1145: artificial intervertebral disc replacement in patients with cervical degenerative disc disease [public summary document]. 29 Nov2011.http:\/\/www.msac.gov.au\/internet\/msac\/publishing.nsf\/Content\/FD4160B6D7E29A41CA25801000123B84\/$File\/1145_PSD.pdf(viewed Sept 2022)."},{"key":"e_1_2_8_13_1","volume-title":"The international statistical classification of diseases and related health problems, tenth revision, Australian modification","author":"Australian Consortium for Classification Development","year":"2016"},{"key":"e_1_2_8_14_1","volume-title":"Australian classification of health interventions","author":"Australian Consortium for Classification Development","year":"2017"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_8_16_1","unstructured":"Australian Department of Health and Aged Care.2020\u201325 National Health Reform Agreement (NHRA): Australian Government;2023.https:\/\/www.health.gov.au\/our\u2010work\/2020\u201025\u2010national\u2010health\u2010reform\u2010agreement\u2010nhra(viewed Jan 2023)."},{"key":"e_1_2_8_17_1","unstructured":"Australian Prudential Regulation Authority.Private health insurance membership trends. 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