Figure 3: Australian Bureau of Statistics, national, state and territory population,
https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release#data-download
Figure 3 shows that in 2020-21 the ratio of total public hospital beds for every 1,000 people aged 65
years and older was 14.7.14
This is in spite of the fact that overall number of public hospital beds increased by 1.2 per cent in
2020-21 compared to the year before.15
This ratio has now been on a downward trend for 27
years and is a major cause of public hospital over-crowding and long waiting times for emergency and
planned surgery treatments.
Unsafe or unsuitable discharge destinations for vulnerable patients at risk of readmission also keeps
public patients admitted longer than is necessary once their acute phase of hospital treatment has
ended.16
As an illustration, in 2020–21, 19,631 public hospital separations were attributed to patients waiting
for aged care services nationally (either a place in a residential aged care facility or an appropriate
home care service).17
Of these patients, around one in 10 waited more than 35 days. The
number of separations, and therefore the number of patients waiting for aged care services, has been
overall increasing since 2011–12.
Delayed access for patients who require an admission, either from the emergency department or for planned
surgery, will almost certainly continue unless these multi-morbid, vulnerable, often elderly patients,
can be safely discharged to the care of a multidisciplinary service team. This is a team who can manage
their condition in the community or within a residential aged care facility.
With the lack of access to multidisciplinary community and primary care (due to geographical and/or
socioeconomic factors), many multi-morbid patients will continue to seek public hospital emergency care
and rely on public hospital admitted beds.
Unless the Commonwealth, State and Territory governments co-invest in additional community service
solutions that fully support these vulnerable patients outside of the hospital, our hospital log jam
will continue; wait times in emergency will continue to increase and the planned surgery waiting lists
will only blow out further.
Emergency department waiting and treatment times
The public hospital system’s ability to cope with Category 2 and Category 3 cases is a crucial measure of
public hospital performance.
Under the Australian Health Performance Framework, two of the public hospital emergency department
performance measures are:
- Proportion of patients seen within the clinically recommended timeframes set by the Australian
Triage Scale; and
- Length of stay for emergency department care, proportion of patients staying for four hours or less.
Percentage of triage category 3 emergency department patients seen within recommneded time (< 30
minutes)
Figure 4: Source: The State of Our Public Hospitals (DoHA 2004 to 2010); Australian Institute of Health
and Welfare (AIHW) Emergency department care (2010-11 to 2021-22): Australian hospital statistics. Note:
National Emergency Admission targets were abolished with effect from 1 July 2015.
In 2021-22 the proportion of Triage Category 3 Emergency Department patients seen within recommended 30
minutes dropped to 58 per cent nationally. This is the lowest number since the AMA started tracking ED
performance in 2002-03.
Patients leaving emergency within four hours
The proportion of emergency department presentations completed within four hours is one important
indicator of whether Australians receive appropriate high quality and affordable hospital care. Patients
are considered to have completed their visit to the emergency department when they physically leave
(regardless of whether they were admitted to the hospital, were referred to another hospital, were
discharged, or left the hospital at their own risk).
Figure 5 shows that in 2021-22, the proportion of people in all triage categories who completed their
emergency presentation within four hours or less was 60.9 per cent. This is a decline of 5.8 per cent
compared to the previous year and a further decline of 9 per cent compared to the pre-pandemic levels –
in 2018-19, 70 per cent of patients completed their emergency department stay within four hours or
less.18,19
This is also the lowest number since 2011.
Translated into hours, this meant that nationally, in the 90th percentile20
patients left the
emergency departments 9 hours after presenting in 2021-22 reporting year. For patients whose visit to
emergency departments ended in hospital admission, the 90th percentile length of emergency department
stay was over 15 hours (15 hours 37 minutes), ranging from 12h 22min in Queensland to 23h 49 min in
Tasmania.21
Although it is likely that the emergency department performance in 2021-22 was influenced by
COVID-19, the proportion of public hospital emergency patients leaving within four hours has been in
decline since 2014-15.
Percentage of emergency department visits completed in four hours or less – all states and territories
Figure 5: Source: Australian Institute of Health and Welfare (AIHW) Emergency department care (2011-12 to
2020-21): Australian hospital statistics.Note: National Emergency Admission targets were abolished with
effect from 1 July 2015
The effect of COVID-19 on emergency department activity
Throughout 2021-22 financial year, COVID-19 continued to impact the performance of public hospitals
differentially around Australia, but as this Report Card shows, the overall performance of public
hospitals declined.
AIHW data indicates that in 2021-22, there were 53,593 admissions from emergency departments for COVID-19
(Emergency use of U07) out of 268,975 presentations. COVID-19 was the third most common principal
diagnosis in emergency department and third principal diagnosis for patients who were subsequently
admitted.22
Planned Surgery Waiting and Treatment times
Planned surgery is any form of surgery considered medically necessary, but which can be delayed for at
least 24 hours. These surgeries are essential and include lifesaving procedures, diagnostic procedures
and procedures which will restore basic functions for someone.
Diagnostic Imaging (DI) radiology tests (such as X-ray, ultrasounds, CT, MRI and nuclear medicine scans
that are interpreted and reported by radiologists) that lead to planned surgery are often a critical
element of the patient treatment process. AMA members report that access to radiology for patients in
the public hospital system is also in decline, with many accounts of patients experiencing distressing
delays in accessing public DI services when requested by their General Practitioners and specialist
referrers. They cite examples of requests for DI referrals that are clinically urgent but can take up to
months for patients to access, for conditions such as breast lumps suspected to be cancer requiring
X-ray mammography, or painful and debilitating musculoskeletal disorders requiring ultrasound or MRI
assessment.
AMA members also report that escalation in demand for radiology due to delays caused by COVID-19 and the
‘hidden waiting list’ have outstripped workforce availability for diagnostic imaging staff, including
radiologists. According to the Australian Institute of Health and Welfare, the volume of diagnostic
imaging services dropped significantly in the June quarter 2020, down to 5.6 million from approximately
6.5 million in previous quarters, after the COVID-19 lockdowns were introduced. The volume of imaging
services bounced back and reached 7.1 million in the June quarter 2021.23
The shortages in workforce availability relative to escalating DI volumes are detrimental to providing
timely radiologist reporting of DI studies to referrers, further delaying patient treatment or
preparation for future surgery. Although measures such as engaging off-site teleradiology services may
alleviate on-site demands, they are not able to replicate the quality of on-site radiologists, who
collaborate with referrers and "value-add" in multidisciplinary meetings to enhance quality patient
care.24
For the planned surgery that is provided in public hospitals, the Australian Health Performance Framework
includes the following two performance indicators that measure the provision of timely planned surgery:
- The median waiting time for planned surgery; and
- The percentage of patients treated within the clinically recommended times.
The effect of COVID-19 on public hospital planned surgery activity during 2021-22 reporting period.
At the start of the COVID-19 pandemic in 2020, an agreement was reached at the national level to
pause public and private hospital planned surgeries from 1 April 2020, except for Category 1 and high
priority Category 2 patients. Shortly after, the Commonwealth announced a partnership with the private
hospital sector to ensure their viability during the private planned surgery pause.25
This
agreement also allowed state and territory governments to enter into private hospital COVID-19
partnership agreements to purchase capacity for public patients, with 50 per cent of the cost covered by
the Commonwealth. State and territory governments have pursued different paths to reaching these
agreements.
Following the decline in planned surgery in 2020, during 2020–21, planned surgery admissions from the
surgery wait lists increased by 10.7%26
across all jurisdictions, with some jurisdictions
exceeding 2019 pre-pandemic volumes. The greatest increase occurred in Category 3 admissions.
The increases are the result of planned surgery recuperation that was initiated after the first wave of
COVID19 in several jurisdictions in 2020–21,27,28,29
specifically with the aim of clearing
the backlog.
AIHW data shows 754,600 admissions to hospital from the public planned surgery waiting lists in 2020–21,
and a subsequent drop in 2021-22 to 618,546, lower even than in 2019-20, the first year of the pandemic
and about 135,000 admissions less than in 2018–19.30
At the same time, 783,715 people were added to the planned surgery waiting list in 2021-22. This is the
lowest number of additions since 2017-18, indicating that the number of patients on the hidden waiting
list – those waiting to see a specialist to be added to the planned surgery list - is growing.
Median waiting time
The median waiting time indicates the number of days within which 50 per cent of patients were admitted
for their planned procedure. This means half of the patients had a shorter wait time than the median,
and half had a longer waiting time.
With increases in admissions from planned surgery waiting lists and additional investment by State and
Territory health departments, nationally in 2021-22, the median wait time for planned surgery was 40
days. This is an improvement of 8 days compared to the year before.
The ratio of additions to the wait list and removals from wait lists due to admissions, plays an
important role in the ability of the system to provide timely medical procedures to patients on the
lists. The data show that over a number of years, the volume of patients being added to the list is
greater than the number who are taken off the list.31 These data reflect the hospital system’s surgical
provision capacity. Such capacity needs to be commensurately scaled up to be able to meet the demand of
a population that is increasing in size, age and in people living with multiple chronic health issues.
Median waiting time for planned surgery (days) – national
Figure 6 Source: Australian Institute of Health and Welfare (AIHW), Australian Hospital Statistics:
Planned surgery data cubes (2001-02 to 2006-07): Australian Institute of Health and Welfare (AIHW),
Australian Hospital Statistics: Planned surgery waiting times (2007-08 to 2021-22).
Planned surgery within clinically recommended timeframes
There are three planned surgery clinical urgency categories:
Category 1 – procedures that are clinically indicated for completion within 30 days;
Category 2 – clinically indicated for completion within 90 days; and
Category 3 – clinically indicated for completion within 365 days.
Even with additional efforts and programs implemented by States and Territories to support planned
surgery provision, and increases in in admissions, nationally, the percentage of Category 2 planned
surgery that was provided within the recommended 90 days dropped to 63 per cent in the 2021-22 reporting
period. This is 7 per cent below the 2020-21 levels32
and 17.5 per cent down on pre-pandemic
2018-19 levels.33
Percentage of Category 2 planned surgery patients admitted within the recommended time (90 days)
All States and Territories
Figure 7 Source: Australian Institute of Health and Welfare (AIHW), Australian Hospital Statistics:
Planned surgery data cubes (2001-02 to 2006-07): Australian Institute of Health and Welfare (AIHW),
Australian Hospital Statistics: Planned surgery waiting times (2007-08 to 2021-22).
During 2021-22 reporting period, more than one in three patients (37 per cent) waited longer than the
clinically indicated 90 days for Category 2 planned surgery.
Although the increase in wait times can, to some extent, be explained by the COVID-19 impact, the
long-term pressure on public hospital beds and operating theatres pre-dates the pandemic. With an
ageing population and hospital capacities not keeping up with population growth, the cumulative public
hospital planned surgery demand will continue to grow from an already high baseline of patients on long
waiting lists.
The majority of States and Territories reintroduced suspensions of planned surgeries in early 2022 to
free up public hospital capacity to manage growing numbers of COVID patients.34,35,36,37,38
The impact of these suspensions and the States trying to catch up can still be felt across the system.
As a result, the cumulative public hospital planned surgery demand will continue to surge. This is on top
of an already high baseline of patients on long waiting lists, surgeries delayed during the multiple
planned surgery cancellations over the past three years, delayed diagnoses and referrals due to the
impact on health seeking behaviour as a result of the pandemic, and natural growth to the planned
surgery waiting list.
Hidden waiting list
Specialist clinics in public hospitals provide planned, non-admitted services to patients. To attend a
specialist clinic, patients must have a referral from their general practitioner, hospital doctor or
other health professional. These specialist attendances often result in patients being added to the
planned surgery waiting lists.
The available data shows that by the time a patient is added to the official planned surgery
waiting list, they have already waited the period between referral from their general
practitioner to the date of a consultation with an out-patient specialist to assess their
surgery urgency or need. This period between the referral and the patient being officially added to the
planned surgery list is known as the ‘hidden waiting list’
Similar to the planned surgery urgency categorisation, the outpatient urgency categories are classified
as:
- Category 1 – specialist consultation recommended within 30 days of being added to the outpatient
wait list
- Category 2 – specialist consultation recommended within 90 days of being added to the outpatient
wait list
- Category 3 – specialist consultation recommended within 365 days of being added to the outpatient
wait list.39
In 2022 the AMA published a report that looked specifically at the hidden waiting lists and the numbers
of patients that were waiting to see specialists in the public hospital system.40
The Report
found that many patients were waiting months and even years for an outpatient appointment, to only be
put on another waiting list to receive surgery. Patients are therefore not fully informed of the actual
waiting time for planned surgery, and the system cannot be resourced properly as the scale of the
problem is unknown.
In addition to this, the way in which the public hospital funding system is set up has direct
implications for the ability of the system to cope with the increasing burden of disease. At the moment,
only the cost of delayed surgery resulting from the overdue time in the actual waiting list is factored
in into the pricing model, i.e., only the wait time after seeing a specialist in the public system.
The AMA argues for and has been calling on the Independent Hospital and Aged Care Pricing Authority to
consider factoring in the cost of delayed access to specialists in the outpatient clinics.41
This is particularly relevant for States like Tasmania where the data available through Tasmanian Health
Service indicates that patients who are assessed as Category 1, for example needing to see a
neurosurgeon 30 days from the referral by their GP, can wait up to 880 days.42
Delayed access to a specialist often results in delayed access to planned surgery, leading to patients
presenting at emergency departments, having more complex health conditions, and requiring longer
recovery.
The planned surgery data available via AIHW for 2021-22 indicate that about 100,000 fewer people were
added to the planned surgery waiting list in 2021-22 than the year before, or any year since
2017-18.43
The likely explanation for the drop is the impact of COVID-19 on specialists
working in public hospitals and the redeployment of hospital resources to manage COVID-19 patients.
Because they are unable to access specialists in the public system following a GP or other health
practitioner referral, a number of patients spend time languishing on the hidden waiting list, before
they are added to the ‘official’ planned surgery waiting list.
What this means in practice is that around 100,000 people without private health insurance or who have
limited access to private hospitals in areas where they live, will be waiting significantly longer to
access the surgery that may relieve them of pain or help them live a more fulfilling life.
Loss of health impacts on productivity and results in increased societal cost. 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. Or a delayed orthopaedic surgery, for example a hip replacement, will incur further costs to
the health system through more consults with the patient’s General Practitioner, more medicine
subsidised by the pharmaceutical benefits scheme, and through income support from the Government due to
an inability to work. This could also lead to further health issues, including mental health issues, for
an individual due to their limited ability to participate in work, physical and social activities.
If Australia is truly aiming towards creating a framework and measuring the wellbeing of its
citizens44
using the indicators such as premature mortality and life
satisfaction,45
then the health outcomes of its citizens must be considered. Both of those
are directly linked with access and availability of affordable healthcare, which this report
demonstrates is declining.
Through the Clear the Logjam campaign, the AMA continues to call for significant investment in public
hospital resourcing not just to overcome delays further exacerbated by COVID-19, but also to restore the
capacity of public hospitals to provide access to surgery to all those who require it within the
clinically indicated time frames.
Funding for public hospitals46
The latest Addendum to the National Health Reform Agreement 2020-25 continues the Commonwealth commitment
to fund 45 per cent of the efficient growth in public hospital activity, capped at 6.5 per cent per
annum. States and Territories must fund all public hospital expenditure over and above this amount.
In response to COVID-19, a National Partnership on Covid-19 Response Agreement was signed between the
Commonwealth and the States that allowed for 50-50 funding share of the costs incurred, to provide
states funding to respond to the COVID-19 outbreaks.47
This Agreement ended on 31 December
2022.
Public hospital expenditure per person (constant prices)
Figure 8 Source: Australian Institute of Health and Welfare (AIHW) 2022, Health Expenditure Australia:
2008-09 to 2019-20 viewed 9 February 2022
https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2019-20/contents/main-visualisations/overview
Graph above shows that State and Territory Governments have, on average over the last ten years, allocated
substantially higher levels of public hospital growth funding per person each year than has the
Commonwealth. The table below compares the rate of growth in per person Commonwealth public hospital
funding in each five-year period over the last decade.
Per person average annual per cent increase in public hospital funding by government source (constant
prices)
|
2008-09 to 2012-13 |
2013-14 to 2017-18 |
2018-19-to 2020-21 |
2008-09 to 2020-21 |
| Commonwealth |
-1.0% |
3.9% |
4.7% |
2.04% |
| All States and Territories |
4.6% |
1.0% |
5.2% |
3.00% |
This rate of per person funding growth from the Commonwealth and State governments falls well short of
that needed to cover annual public hospital input increases (including wages growth), plus a higher
volume of services to provide timely patient treatment.
Significant effort will be required from both the Commonwealth and the State and Territory governments to
improve public hospital performance. While the Commonwealth will need to increase its share by a greater
amount, the States and Territories must also invest to improve hospital performance.
The AMA is calling for the Commonwealth to increase its contribution to 50 per cent for activity-based
funding. This increase would require the States and Territories to reinvest the 5 per cent into public
hospitals. Furthermore, the removal of the Commonwealth’s annual growth cap would allow public hospitals
to meet community demand, meaning an indirect increase in funding from all governments due to increased
activity. Funding to address demand and expand capacity would be partnership funding, shared between the
Commonwealth and States and Territories. Commonwealth funding for pay-for-performance targets would only
be paid if States and Territories improved their public hospital performance.48
3Source: Australian Institute of Health and Welfare (AIHW) 2022, Australian Hospital Statistics: Hospital Resources 2020-21 data tables, Table 4.5, https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients
4Ibid.
5Ibid.
6Australian Bureau of Statistics, 2022 National State and territory population, Data downloads – data cubes, Population by age and sex – national: https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/jun-2022
7Australian Institute of Health and Welfare 2022. Australian hospital statistics. Admitted patient care 2020-21: Who used these services, Table 3.1: Separations and patient days, by age group and sex, all hospitals, 2020–21https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients
8Ibid.
9Australian Institute of Health and Welfare 2021.Australian hospital statistics. Admitted patient care 2020–21: Who used these services, Table 3.1: Separations and patient days, by age group and sex, all hospitals, 2020–21 https://www.aihw.gov.au/reports-data/myhospitals/sectors/admitted-patients
10Parliament of Australia 2008. Department of the Parliament Library – Publications. Population projections 2007 to 2057 https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook43p/ageingpopulationfigure
11AIHW 2022. Admitted patient care 2020-21, Table 1: Separations with COVID-19 diagnosis, states and territories, Australia, 2020-21
12Australian Medical Association 2021. Public Hospitals Cycle of Crisis. https://www.ama.com.au/sites/default/files/2022-10/Public%20hospitals%20-%20cycle%20of%20crisis.pdf
13Australian Medical Association 2021. Public Hospitals Cycle of Crisis. https://www.ama.com.au/sites/default/files/2022-10/Public%20hospitals%20-%20cycle%20of%20crisis.pdf
14Australian Institute of Health and Welfare (AIHW) 2022 Australian Hospital Statistics: Hospital Resources 2020-21, Table 4.5 https://www.aihw.gov.au/getmedia/fb227d5e-0084-487d-b921-0ac5c6f65803/Hospital-resources-2019-20-data-tables-17-August-2021.xlsx.aspx; https://www.aihw.gov.au/reports-data/myhospitals/content/data-downloads
15Ibid.
16Australian Medical Association 2023. Hospital exit block: a symptom of a sick system report. https://www.ama.com.au/articles/hospital-exit-block-symptom-sick-system
17Australian Government Productivity Commission (2023). Report on Government Services 2023: Chapter 14 aged care services. Retrieved 24/01/2023 from: https://www.pc.gov.au/ongoing/report-on-government-services/2023/community-services/aged-care-services
18Australian Institute of Health and Welfare (AIHW) 2021. Australian hospital statistics: Emergency Department Care 2019-20 viewed 8 August 2021 https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care
19Australian Institute of Health and Welfare 2021, Australian hospital statistics: Emergency department care 2018-19, Table 6.4 viewed 31 July 2021 https://www.aihw.gov.au/getmedia/6f15c095-e669-428c-9cef-a887cb65f3b0/Emergency-department-care-2018-19.xlsx.aspx
20The 90th percentile number expression means that among 90 per cent of patients there will be those whose stay at Emergency Department will be 9 hours. According to AIHW, the 90th percentile is the maximum amount of time which 90% of patients spent in the emergency department. For the remaining 10% of patients, the length of stay was longer. More information available here: https://www.aihw.gov.au/reports-data/australias-health-performance/australias-health-performance-framework/national/all-australia/access/accessibility/2_5_8
21Australian Institute of Health and Welfare (AIHW) 2023. Australian hospital statistics: Emergency Department Care 2021-22, Table 6.1 viewed 14 February 2023 https://www.aihw.gov.au/getmedia/0d0d6cbf-e764-4a89-a71a-b03c5156235d/Emergency-Department-Care-2020-21.xlsx.aspx https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care
22Australian Institute of Health and Welfare (AIHW) 2023. Australian hospital statistics: Emergency Department Care 2021-22, Table 4.9 and Table 4.10 https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care
23Australian Institute of Health and Welfare (AIHW) 2022. Diagnostic services. Pathology, imaging and other diagnostic services https://www.aihw.gov.au/reports/diagnostic-services/pathology-imaging-and-other-diagnostic-services
24Note: Due to lack of quantitative data, this Report Card and the future AMA Public Hospital Report Cards will rely on AMA members to provide qualitative feedback.
25Hunt, G. MP 2020. Minister’s Hunt Media – Media Release: Australian Government partnership with private health sector secures 30,000 hospital beds and 105,000 nurses and staff, to help fight COVID-19 pandemic https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australian-government-partnership-with-private-health-sector-secures-30000-hospital-beds-and-105000-nurses-and-staff-to-help-fight-covid-19-pandemic
26Australian Institute of Health and Welfare (AIHW) 2022. Hospital activity planned surgery https://www.aihw.gov.au/reports-data/myhospitals/intersection/activity/eswt
27NSW Health Annual Report 2020-21. Response to the COVID pandemic https://www.health.nsw.gov.au/annualreport/Publications/2021/a-pandemic-emerges.pdf
28Andrews, D. Premier of Victoria 2020. Media Statement: COVID-19 Capacity Boost As Planned Surgery Blitz Starts https://www.premier.vic.gov.au/covid-19-capacity-boost-planned-surgery-blitz-starts
29Queensland Government Deputy Premier and Minister for Health and Minister for Ambulance Services The Honourable Steven Miles Media Statement June 2020. Quarter of a billion dollar planned surgery blitz https://statements.qld.gov.au/statements/90009
30Australian Institute of Health and Welfare (2022) AIHW Media Releases Public hospitals worked to clear planned surgery backlog during 2020–21 https://www.aihw.gov.au/news-media/media-releases/2021/january-1/public-hospitals-worked-to-clear-planned-surgery#:~:text=There%20were%20893%2C000%20patients%20added,number%20added%20in%202018%E2%80%9319.&text=Information%20on%20Emergency%20department%20care,the%20AIHW%20in%20December%202021
31Australian Government. Productivity Commission 2022. Report on Government Services 12. Public Hospitals Table 12A.33 https://www.pc.gov.au/research/ongoing/report-on-government-services/2022/health/public-hospitals
32Australian Institute of Health and Welfare 2021. Australian hospital statistics: Planned surgery waiting times 2020-21 Tables 4.11–4.18 https://www.aihw.gov.au/getmedia/f72949da-cba8-4f36-a47d-2c5bbcccd55a/Planned-surgery-waiting-times-2019-20.xlsx.aspx
33Australian Institute of Health and Welfare 2020. Australian Hospital Statistics: Planned surgery waiting times 2018-19 Tables 4.11-4.18 https://www.aihw.gov.au/getmedia/5042f8a8-4711-455a-9c6d-60650f954fbe/Planned-surgery-waiting-times-2018-19.xlsx.aspx
34 Andrews, D. Premier of Victoria 2022. Media statement: Pandemic Code Brown To Support Hospitals https://www.premier.vic.gov.au/pandemic-code-brown-support-hospitals
35 Victorian Government Department of Health 2022. Media statement: Changes to non-urgent surgery settings helping hospitals respond to Omicron https://www.health.vic.gov.au/media-releases/changes-to-non-urgent-surgery-settings-helping-hospitals-respond-to-omicron
36 D'Ath, Y. Minister for Health and Ambulance Services 2022. Media statement: Non-urgent planned surgeries postponed https://statements.qld.gov.au/statements/94231
37 Stevens, G. 2022. Emergency Management (Appropriate Surgery During COVID-19 Pandemic No 6) Direction 2022 https://www.covid-19.sa.gov.au/__data/assets/pdf_file/0011/584309/Emergency-Management-Appropriate-Surgery-During-COVID-19-Pandemic-No-6-Direction-06012022.pdf
38 NSW Government 2022. Media release: Support measures for hospitals, community https://www.nsw.gov.au/media-releases/support-measures-for-hospitals-community
39 Queensland Government Queensland Health 2022. Queensland Reporting Hospitals – Outpatient Indicators http://www.performance.health.qld.gov.au/Home/SpecialistOutpatientIndicators/99999?Indicator=Category1
40 Australian Medical Association 2022. Planned Surgery Hidden Waiting List https://www.ama.com.au/planned-surgery-hidden-waiting-list
41 Australian Medical Association 2022. IHPA Pricing Framework 2023-24. AMA submission to Independent Hospital Pricing Authority Consultation https://www.ama.com.au/articles/2023-24-public-hospital-pricing-framework
42 Tasmanian Health Service 2023. Estimated Outpatient Waiting Times – Southern Region. https://outpatients.tas.gov.au/clinicians/wait_times/wait_times
43 Australian Institute of Health and Welfare 2022. Australian hospital statistics: Planned surgery waiting times 2021-22 Table 2.1: Additions and removals from public hospital planned surgery waiting lists, 2017–18 to 2021–22.
44 Australian Government The Treasury 2022. Measuring what matters: https://treasury.gov.au/consultation/measuring-what-matters-2022
45 Australian Government The Treasury 2022. OECD Framework Indicators. https://treasury.gov.au/sites/default/files/inline-files/OECD_framework_indicators.pdf
46 Note that the most recent public hospital funding data available via AIHW is 2020-21, to the end of the financial year in June 2021, whereas the data on planned surgeries and emergency department activity covers 2021-22 financial year
47 Federal Financial Relations 2020. National Partnership on Covid-19 Response. https://federalfinancialrelations.gov.au/sites/federalfinancialrelations.gov.au/files/2021-04/covid-19_response_vaccine_amendment_schedule.pdf
48Australian Medical Association 2021. Public Hospitals – Cycle of Crisis https://www.ama.com.au/sites/default/files/2021-10/Public%20hospitals_Cycle%20of%20crisis_online%20%281%29.pdf
