Prof Stephen Robson
Federal AMA President
The AMA has been publishing the Public Hospital Report Card since 2007 with health data going back to 2002. We started the report card as a way to both monitor the performance of our public hospitals and propose solutions to improve performance and reduce wait times.
As the eighth AMA President to introduce a report card, it’s disappointing to see that 16 years after the first report hospital performance is at its lowest ever. Wait times have continued to blow out and the solutions put forward by the AMA over successive years continue to be ignored.
The decline in performance is represented in the numbers. Over the last 30 years, the number of public hospital beds available for people aged over 65 has dropped by more than half — from 32.5 beds per 1,000 people to only 14.7. This is happening while our demographics are shifting. In just over 10 years, Australia is expected to have more than 1 million people who will be over 85 years of age. We know that older patients are more likely to require an admission to a public hospital, and we should be planning for this. Instead, we are deliberately setting our public hospitals, and with them our patients, on the path to failure.
This year we saw emergency departments (ED) face their toughest year since the AMA began tracking ED performance. Only 58 per cent of patients triaged as urgent were seen within the recommended 30 minutes, with one in three patients staying longer than four hours in EDs, often because there aren’t beds available in hospitals to safely admit them.
We also saw wait times for planned surgeries continue to blow out in the last financial year, with only 63 per cent of patients referred for semi-urgent planned surgery treated within the recommended 90 days. That’s more than one in three patients waiting longer than the clinically indicated time for essential surgeries, often in terrible pain and unable to work.
I use the term ‘planned surgery’ here because this better reflects what it is as opposed to the term ‘elective surgery.’ We will use this term throughout the report card. Planned surgery better reflects the medical necessity of a surgery that will improve a patient’s health and wellbeing or diagnose a potentially life-threatening illness. These surgeries are planned and scheduled in accordance with a triage scale and the health system’s capacity. We are doing this to avoid any potential misunderstanding of the term “elective” by the broader public. These surgeries are essential.
Meanwhile, access to specialists in the public hospital system — the ‘hidden waiting list’ for outpatient appointments — continues to be a huge problem. Without these appointments, people can’t be assessed and added to the actual surgical waiting list. As a result, around 100,000 fewer people were added to the planned surgery waiting list in 2021–22. This shows our hidden wait list is continuing to grow.
These are significant problems, but there are solutions. We need a new funding agreement to support hospitals to expand their capacity and improve their performance — to clear the hospital logjam.
We need a health budget in May, that includes additional funds to address the elective surgery backlog. Longer term we need a new national hospital funding agreement — one that has a fair 50-50 funding split at its heart, but also provides the resources our hospitals need to grow, improve, and keep you healthy.
The public hospital system's ability to cope with emergency and urgency cases is a crucial measure of public hospital performance.Learn more
Public hospital capacity
Emergency department waiting and treatment times
Planned Surgery Waiting and Treatment times
Hidden waiting list
Funding for public hospitals
The number of available public hospital beds relative to the size of the Australian population is a broad indicator of whether a person will receive a timely admission if it is requiredLearn more
In 2020-21 the ratio of total public hospital beds for every 1,000 people aged 65 years and older was close to 14.7.
A 0.8 per cent increase in the population 65 and over in 2020-21 resulted in 5.43 per cent increase in hospital separations and 2.87 per cent increase in patient days.
In 2021-22 the proportion of Triage Category 3 Emergency Department patients seen within recommended 30 minutes dropped to 58 per cent nationally, the lowest number since the AMA started tracking ED performance in 2002-03.
To attend a specialist clinic, people must have a referral from their GP, hospital doctor or other health professional. These specialist attendances often result in patients being added to the elective surgery waiting lists.Learn more
In Tasmania in 2022 patients who are assessed as Category 1, for example needing to see a neurosurgeon 30 days from the referral by their GP, were expected to wait for 880 days.
In Queensland there are over 280.000 patients on the Specialist Outpatient Waiting List, an increase of around 40,000 compared to last year.
Less than one in two children with Category 2 referrals (to be seen in 90 days) from their GPs in Queensland are seen within clinically recommended times (Paediatric Medicine 48.7%).