Public Hospital Report Card

An AMA analysis of Australia’s Public Hospital System

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Public Hospital Report Card 2022

President's Introduction

dr omar khorshid

Dr Omar Khorshid

Federal AMA President

Australia’s public hospitals are in crisis. Our experiences on the front line have been verified by the data in this year’s AMA Public Hospital Report Card. Problems that have existed for years have only been amplified by COVID-19. It’s time to fix this mess through better funding and more innovation.

The Report Card data show that since 2008 we have lost 6 public hospital beds for every 1000 persons over the age of 65. Whereas 30 years ago we had over 30 beds in our public hospital system per 1000 people over the age of 65, we now have less than 15. At the same time our population is ageing. We expect that by 2035 over one million people will be older than 85, almost double what it is today. 2035 is not that far away. If we want to save our public hospital system, we must act now.

This year’s data demonstrates the growing pressure on our emergency departments. More than one in three people will wait longer than the clinically recommended 30 minutes to receive urgent care. One in three people who present to an ED will wait longer than four hours to be either discharged or admitted. This is why we see increased ramping of ambulances in front of our hospitals and why patients are suffering unnecessarily. There just isn’t enough capacity to meet the growing demand and little appreciation of the role primary care can play in keeping people out of hospital.

The situation is even worse when it comes to elective surgery. We continue to see more people being added to the elective surgery waiting lists than are taken off the lists through provision of surgery. As this Public Hospital Report Card shows, during 2020-21 reporting period, for Category 2 elective surgery – procedures like heart valve replacements or coronary artery bypass surgery, one in three patients waited longer than the clinically indicated 90 days, a performance decline of 17 per cent since 2016-17.

When it comes to orthopaedic surgery, waiting times continue to blow out. Over 20 percent of patients, one in five, waited over a year for a hip replacement surgery in 2020-21. The figure is even worse for knee replacements with almost one in three (31.7 per cent) patients waiting longer than clinically indicated 365 days. That’s almost three times the increase compared to the year before when only 11.4 per cent waited over a year.

Our public hospital capacity must be increased to meet the demands of a population that is increasing in size, age and suffering from multiple chronic health issues. This needs to be backed by greater investment in primary care, giving GPs the support they desperately need to keep people out of hospital.

Our health policy decision makers need to understand and recognise that costs associated with inadequate prevention and delayed elective surgeries go beyond the health system. Every delayed surgery has an impact, leading to loss of quality of life and further deterioration of health. Delaying a minor surgical intervention to improve the hearing of a child may mean they miss crucial time for physical and mental development. This is likely to incur much larger costs throughout their life than the cost of surgery. All these costs are covered by taxpayers and should not be seen as separate. We need all levels of government to stop shifting the costs and work together to solve these problems.

Australia urgently needs a recovery plan for its public hospital system. We need appropriate funding to clear the backlog of elective surgeries, and to build enough capacity to meet the growing needs of the community.

The AMA has a solution. Our four-point plan proposes:

  • Improved performance by reintroducing funding for performance improvement;
  • Expanded capacity for public hospitals through additional funding for extra beds and staff;
  • Addressing demand for out-of-hospital alternatives, prioritising programs that work with GPs; and
  • Increased funding and removal of funding cap by increasing the Commonwealth contribution to 50 per cent for activity.

We need to end the blame game that often stifles innovation and to agree on a range of measures to support general practice deliver the type of care that will help keep people out of hospital and enjoy a better quality of life.

Public Hospital Performance Indicators

The public hospital system's ability to cope with emergency and urgency cases is a crucial measure of public hospital performance.

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Emergency Department

Elective Surgery

Waiting and treatment times

National Public Hospital Performance

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 required

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In 2019-20 the ratio of total public hospital beds for every 1,000 people aged 65 years and older was close to 14.9.

In 2020-21, the number of emergency department presentations (all categories) increased by 6.9 per cent compared to 2019-20.

Triage Category 3 (Urgent) emergency department presentations in 2020-21 financial year seen within recommended time (less than 30 minutes) dropped to 63 per cent.

Hidden Waiting Lists

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.

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In Tasmania in 2021 there were over 57,000 patients waiting to see a specialist in the public health system for their medical condition.

In Queensland there were over 240.000 patients on the Specialist Outpatient Waiting List.

Almost one in two children with Urgent referrals from their GPs in Queensland are not seen within clinically recommended times (Paediatric Medicine 55.1%).

State by State Public Hospital Performance

View the hospital performance of each state

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