Last month, a new report on the state of healthcare in Australia was released by the Australian Institute for Health and Welfare (AIHW). The publication, entitled Australia’s Health 2020, has come under fire for presenting outdated information, with some of the numbers dating back to 2017-18 or earlier.
However, these are the latest figures available at a national level and they provide a useful backdrop against which recent and future events can be set. The bi-annual report covers a range of topics, such as life expectancy, chronic conditions, prescriptions and social determinants of health; but what does it tell us about the health system itself?
More than 2 in 5 Australians have private hospital cover
The figures show that in June 2019, 11.2 million Australians (44% of the population) had some form of private patient hospital cover, and 13.6 million (53%) had general treatment cover. Unsurprisingly, more than 4 in 5 hospitalisations in private hospitals were funded by private health insurance.
The healthcare workforce is growing rapidly
Between 2013-14 and 2017-18, the Australian registered health workforce increased by 16%. In 2018, there were more than 586,000 registered health practitioners in Australia, including 334,000 nurses and midwives and 98,400 medical practitioners.
The number of hospital beds has increased
The report states that in 2018, there were around 2.5 public hospital beds per 1,000 people. The number of public hospital beds (per population) was relatively stable between 2013-14 and 2017-18, while number of private hospital beds increased slightly to reach 1.4 per 1,000 people.
In real terms though, the number of hospital beds increased by 1.3% per year on average. In 2018, there were 62,000 beds in 693 public hospitals across Australia. The number of private hospitals (including day hospital facilities) in 2016–17 was 657.
The average length of a hospital stay is decreasing
In 2018-19 there were 11.5 million hospitalisations in total, of which 6.9 million were to public hospitals. The total number of hospitalisations rose faster than Australian population growth, at an average of 3.7% each year in public hospitals and 2.6% in private hospitals.
Out of all hospitalisations, 33% were for patients who were admitted and discharged on the same day in a public hospital and 27% were for 1 or more nights in a public hospital. Same-day hospitalisations in private hospitals accounted for 29%, with 11% involving an overnight stay.
The average length of stay in hospital is decreasing; between 2014–15 and 2018–19, the average length of stay in hospital decreased slightly from 2.8 days to 2.7 days.
Median waiting times for elective surgery are longer
The data shows that in 2018-19, 2.3 million hospitalisations were for elective surgery, of which around two-thirds occurred in private hospitals.
Over the past five years, the number of patients added to the elective surgery waiting list has increased by an average of 2.5% per year, while admissions from public hospital waiting lists have increased by 2.1% each year, on average. Elective surgery waiting times for individual procedures varies by state and territory, but has remained fairly constant for the whole of Australia over the past 5 years.
Waiting time data is not available for patients admitted from private hospital waiting lists, but the median waiting time for elective surgery in public hospitals has increased from 35 days to 41 days over the past five years. Ten years ago the median waiting time was 33 days.
Emergency department visits are increasing
As in other countries, visits to Australian emergency departments are increasing. Between 2014–15 and 2018–19, emergency department presentations increased by an average of 3.2% each year, above the rate of population growth. In total, there were 8.4 million presentations to public hospital emergency departments in 2018-19, representing an average of more than 23,000 each day.
Fewer people are seen within the target time – the proportion of emergency department presentations ‘seen on time’ has decreased from 74% to 71% over the past five years. Emergency department waiting time is defined as the time from presentation in the emergency department to commencement of clinical care.
Spending on hospitals has increased
During 2017–18, a total of $74.0 billion was spent on Australia’s public and private hospitals, with 42% of this funded by state and territory governments and 36% by the Australian Government. The remaining 23% came from non-government sources. Spending per person has increased by an average of 2.1% per year over the past five years.
What can we expect in 2020?
These figures provide a useful snapshot of Australia’s health system as a whole. However, some of the numbers are out of date and in some cases the report presents figures from 2014-15 as current. Aside from this making the data 5 years old, it can cause an issue with comparing and combining data to provide a complete picture of the state of Australian healthcare.
It is likely that 2020 will produce a very different set of figures. The suspension of elective surgery, the drop in primary care visits and emergency attendances, and the reconfiguration of services to care for Covid-19 patients will have impacted on most of the datasets presented here; including elective surgery activity, emergency department presentations, admissions and spending on hospitals.
The decision to suspend data collection for certain services during the pandemic, such as elective surgery waiting times and cancelled operations, and the fact that different states have taken a different approach to this, may also present an issue going forward. However, the pandemic has also emphasised the importance of collecting data at a national level, and new datasets and better processes have been implemented as a result.
In terms of expectations for 2020, indications are that private healthcare cover may have reduced, but that the healthcare workforce is continuing to grow, although there is some concern the numbers aren’t enough. The number of bed spaces – at least ICU beds – has increased as there has been a conscious effort to expand capacity with early targets to triple ICU capacity.
Elective surgery activity is likely to have seen a fall since March, but where there is sufficient capacity to upscale activity, levels could increase substantially towards the end of the year to make up for the shortfall and to clear backlogs.
Emergency department visits fell during the pandemic but recovered relatively quickly through the winter, although for the year as a whole are likely to be at a lower level, while spending on hospitals should be up in 2020 as extra funding has been needed to provide for Covid-19 patients and address waiting lists.
To view the full report, which provides a much wider perspective, visit the Australia’s Health 2020 website.
