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Report on Government Services 2015

Chapter 11, Volume E

Public hospitals

The Public hospitals chapter (chapter 11) of the Report on Government Services reports on the performance of governments in providing public hospitals, with a focus on acute care services. It also reports separately on a significant component of the services provided by public hospitals - maternity services.

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  • Key Facts
  • Indicator Framework
  • Indicator Results

Public hospitals

Total recurrent expenditure on public hospitals (excluding depreciation) was $41.7 billion in 2012-13. In 2012-13, government real recurrent expenditure on public hospitals was $1819 per person for Australia, up from $1616 in 2008-09 (in 2012-13 dollars).

Funding for public hospitals comes from a number of sources. The Australian, State and Territory governments contributed 91.0 per cent of funding for public hospital services in 2012-13. Public hospital services accounted for 41.8 per cent of government recurrent expenditure on health services in 2012-13.

Non government sources contributed 9.0 per cent of all recurrent expenditure on public hospital services in 2012-13. Non-government sources include health insurance funds, individuals, workers' compensation and compulsory third-party motor vehicle insurers.

In 2012-13, Australia had 746 public hospitals (including 17 psychiatric hospitals). Although 71 per cent of hospitals had 50 or fewer beds, these smaller hospitals represented only 15 per cent of total available beds.

There were approximately 5.5 million separations from public (non psychiatric) hospitals in 2012-13. Nationally, this translates into 231.6 separations per 1000 people. Acute separations accounted for 95.1 per cent of separations from public hospitals. Of the total number of separations in public (non psychiatric) hospitals, 50.4 per cent were for same day patients.

A total of 54.1 million individual occasions of service were provided to non-admitted patients in public acute hospitals in 2012-13.

Public hospitals services aim to provide acute and specialist services that are:

  • safe and of high quality
  • appropriate and responsive to individual needs
  • affordable, timely and accessible
  • equitably and efficiently delivered.

Maternity services

Maternity services accounted for 8.5 per cent of total acute separations in public hospitals and 10.6 per cent of the total cost of all acute separations in public hospitals in 2012-13.

In Australian public hospitals in 2012-13, vaginal deliveries accounted for a substantial proportion of the separations for pregnancy, childbirth and the puerperium (41.9 per cent). In public hospitals, vaginal deliveries comprised the largest number of overnight acute separations of all overnight separation categories (4.6 per cent of all separations) with a cost of $775.6 million.

Maternity services aim to provide acute and specialist services that are:

  • safe and of high quality
  • appropriate and responsive to individual needs
  • affordable, timely and accessible
  • equitably and efficiently delivered.

Public hospitals

The performance indicator framework provides information on equity, efficiency and effectiveness, and distinguishes the outputs and outcomes of public hospitals. The performance indicator framework shows which data are complete and comparable in the 2015 Report.

Public hospitals indicator framework

Maternity services

The performance indicator framework provides information on equity, efficiency and effectiveness, and distinguishes the outputs and outcomes of maternity services. The performance indicator framework shows which data are complete and comparable in the 2015 Report.

maternity services indicator framework

Public hospitals

An overview of the Public hospitals performance indicator results are presented. Information to assist the interpretation of these data can be found in the indicator interpretation boxes in the Public hospitals chapter and attachment tables.

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Effectiveness — Access indicators

Emergency department waiting times, 2013-14

Most recent data for this measure are complete but not directly comparable (chapter 11).

Proportion of patients seen on time (%)
  NSW Vic Qld WA SA Tas ACT NT Aust
Resuscitation 100 100 100 100 100 100 100 100 100
Emergency 83 84 80 86 74 85 83 61 82
Urgent 76 73 67 58 65 66 50 51 70
Semi-urgent 80 71 75 71 77 71 57 53 75
Non-urgent 94 88 92 94 92 90 86 89 92
Total 81 75 73 70 73 72 61 57 75
Source: Attachment tables 11A.18, 11A.23, 11A.24 and 11A.47.
Percentage of presentations where the time from presentation to physical departure (Emergency Department Stay length) is within four hours.
  NSW Vic Qld WA SA Tas ACT NT Aust
% 73.9 69.0 76.3 79.5 64.5 67.7 61.8 61.6 72.7
Source: Attachment tables 11A.18, 11A.23, 11A.24 and 11A.47.

Waiting times for admitted patient services

Most recent data for this measure are complete but not directly comparable (chapter 11).

Elective surgery waiting times: Number of days waited, 2013-14
  NSW Vic Qld WA SA Tas ACT NT Aust
50th percentile 49 35 28 29 35 45 48 36 36
90th percentile 329 222 186 142 180 401 270 183 262
Source: Attachment tables 11A.18, 11A.23, 11A.24 and 11A.47.
Elective surgery waiting times: Proportion who waited more than 365 days, 2013-14
  NSW Vic Qld WA SA Tas ACT NT Aust
% 1.8 3.2 2.8 0.7 0.8 11.5 4.7 2.8 2.4
Source: Attachment tables 11A.18, 11A.23, 11A.24 and 11A.47.
Proportion of presentations to emergency departments with a length of stay of 4 hours or less ending in admission, public hospitals (%), 2013-14
  NSW Vic Qld WA SA Tas ACT NT Aust
Resuscitation 51 57 59 66 54 58 63 46 56
Emergency 43 49 53 58 37 33 45 21 47
Urgent 40 44 51 51 35 25 29 21 43
Semi-urgent 44 45 57 52 42 28 33 22 46
Non-urgent 65 60 68 60 59 44 45 50 62
Total 42 46 53 53 38 28 34 22 45
Source: Attachment tables 11A.18, 11A.23, 11A.24 and 11A.47.

Effectiveness — Appropriateness indicators

Separation rates for selected procedures

Most recent data for this indicator are complete and comparable (chapter 11).

Separation rates for selected procedures, public hospitals, per 1000 people (age standardised), 2012-13
  NSW Vic Qld WA SA Tas ACT NT Aust
Cataract extraction 2.7 3.0 1.6 4.7 3.4 2.0 4.1 6.7 2.8
Cholecystectomy 1.4 1.5 1.2 1.2 1.5 1.4 1.4 1.2 1.4
Coronary angioplasty 0.9 0.8 0.8 0.8 0.9 1.0 2.0 .. 0.9
Coronary artery bypass graft 0.3 0.3 0.3 0.2 0.3 0.3 0.5 .. 0.3
Cystoscopy 1.6 2.9 2.0 3.3 2.7 1.6 3.0 2.0 2.3
Haemorrhoidectomy 1.0 0.8 0.3 0.5 0.5 0.6 0.3 0.9 0.7
Hip replacement 0.6 0.7 0.5 0.8 0.7 0.7 1.0 0.6 0.6
Hysterectomy 1.0 1.1 1.0 1.0 1.2 1.2 0.9 0.8 1.0
Inguinal herniorrhaphy 1.0 1.0 0.8 1.0 1.0 1.0 1.0 1.0 1.0
Knee replacement 0.7 0.5 0.5 0.7 0.6 0.4 0.7 0.5 0.6
Myringotomy 0.5 0.7 0.6 0.8 1.4 0.5 0.5 0.6 0.7
Prostatectomy 0.9 1.0 0.7 0.9 1.0 0.8 1.1 0.5 0.9
Septoplasty 0.3 0.4 0.2 0.2 0.5 0.1 0.3 0.2 0.3
Tonsillectomy 0.9 1.3 0.8 0.9 1.5 0.7 0.8 1.0 1.0
Varicose veins, stripping and ligation 0.2 0.3 0.1 0.1 0.3 <0.1 0.5 0.2 0.2
Legend: .. Not applicable.
Source: Attachment table 11A.48.

Effectiveness — Quality — Safety indicators

Unplanned hospital readmission rates

Most recent data for this indicator are complete but not directly comparable (chapter 11).

Unplanned hospital readmissions within 28 days of selected surgical admissions, 2012-13. Surgical, procedure prior to separation, rate per 1000 separations.
  NSW Vic Qld WA SA Tas ACT NT Aust
Knee replacement 21.6 15.1 35.1 22.3 18.6 37.0 np 22.4
Hip replacement 18.0 16.1 16.1 15.9 19.3 29.6 12.9 np 17.5
Tonsillectomy and adenoidectomy 30.3 29.1 35.7 42.4 37.5 51.9 44.7 83.0 33.1
Hysterectomy 31.6 25.9 31.8 43.6 28.7 52.0 23.1 np 30.6
Prostatectomy 27.3 26.5 40.7 33.9 28.9 57.8 np np 31.1
Cataract surgery 3.4 3.0 4.6 2.6 2.9 4.4 0.9 6.0 3.4
Appendicectomy 22.4 22.8 22.0 29.0 27.0 26.5 20.4 43.5 23.1
Legend: – Nil or rounded to zero; np Not published.
Source: Attachment tables 11A.50-11A.55.

Accreditation

Most recent data for this indicator are complete and comparable (chapter 11).

Proportion of accredited beds, public hospitals 2012-13
  NSW Vic Qld WA SA Tas ACT NT Aust
% 97 100 95 100 100 87 100 100 98
Source: Attachment tables 11A.50-11A.55.

Adverse events in public hospitals

Most recent data for this measure are complete but not directly comparable (chapter 11).

Healthcare associated infections in acute care hospitals per 10 000 patient days, 2013-14
  NSW Vic Qld WA SA Tas ACT NT Aust
  0.9 0.8 0.9 0.9 0.6 0.9 0.8 1.0 0.9
Source: Attachment tables 11A.50-11A.55.

Most recent data for this measure are complete and comparable (chapter 11).

Separations with an adverse event, public hospitals: Events per 100 separations, 2012-13
  NSW Vic Qld WA SA Tas ACT NT Aust
Total 6.3 6.8 6.3 6.4 7.2 8.2 7.4 3.4 6.5
Source: Attachment tables 11A.50-11A.55.

Most recent data for this measure are complete and comparable (chapter 11).

Separations for falls resulting in patient harm in hospitals, per 1000 separations, 2012-13
  NSW Vic Qld WA SA Tas ACT NT Aust
  4.8 3.5 3.5 3.6 4.3 5.3 3.8 1.6 4.0
Source: Attachment tables 11A.50-11A.55.

Efficiency — Sustainability indicators

Workforce sustainability

Most recent data for this indicator are complete and comparable (chapter 11) .

Nursing workforce by age group (%), 2013
  NSW Vic Qld WA SA Tas ACT NT Aust
<30 15.1 17.7 15.1 16.8 14.4 12.7 16.6 18.5 15.9
30-39 20.1 21.0 20.7 20.6 19.2 15.2 21.8 25.7 20.4
40-49 23.9 25.2 27.2 25.7 25.8 26.7 25.5 21.9 25.4
50-59 29.1 26.0 26.8 26.4 30.7 34.4 26.2 24.4 27.7
60+ 11.7 10.1 10.3 10.5 9.9 11.0 9.8 9.5 10.6
Source: Attachment tables 11A.56-11A.59.
Medical practitioner workforce by age group (%), 2013
  NSW Vic Qld WA SA Tas ACT NT Aust
<30 8.8 10.6 9.8 12.1 10.2 9.8 9.7 11.0 10.0
30-39 26.3 28.4 28.9 28.3 26.6 24.0 27.3 36.5 27.6
40-49 24.0 23.5 25.8 25.5 25.4 25.9 25.5 23.2 24.6
50-59 21.1 20.9 20.9 19.7 20.5 23.7 21.4 17.5 20.9
60+ 19.8 16.6 14.5 14.3 17.3 16.6 16.2 11.9 17.0
Source: Attachment tables 11A.56-11A.59.

Efficiency indicators

Cost per casemix adjusted separation

Most recent data for this indicator are complete but not directly comparable (chapter 11).

Recurrent cost per casemix adjusted separation, dollars, 2011-12
  NSW Vic Qld WA SA Tas ACT NT Aust
Total recurrent 5280 4693 5246 5733 5251 6033 6384 6017 5204
Capital 475 804 424 542 395 427 556 693 493
Source: Attachment tables 11A.60-11A.72.

Relative stay index

Most recent data for this indicator are complete and comparable (chapter 11).

Relative stay index, 2012-13
  NSW Vic Qld WA SA Tas ACT NT Aust
Total 1.04 0.93 0.86 0.98 1.04 1.01 1.02 1.13 0.97
Source: Attachment tables 11A.60-11A.72.

Recurrent cost per non-admitted occasion of service, 2012-13

Most recent data for this indicator not complete or not directly comparable (chapter 11). Data are available in tables 11A.65-11A.69.

Outcome indicators

Patient satisfaction, 2013-14

Most recent data for this indicator are complete and comparable (chapter 11).

Proportion (%) of persons who went to an emergency department in the last 12 months reporting:
Emergency department (ED) doctors, specialists or nurses always or often listened carefully to them
  NSW Vic Qld WA SA Tas ACT NT Aust
Doctors / specialists 86.6 84.9 84.4 86.7 86.8 76.9 75.2 90.6 85.4
Nurses 90.2 89.7 90.4 87.0 90.3 85.3 81.7 90.6 89.1
Source: Attachment tables 11A.73-11A.88.
ED doctors, specialists or nurses always or often showed respect to them
  NSW Vic Qld WA SA Tas ACT NT Aust
Doctors / specialists 87.2 86.2 86.1 87.4 86.3 85.5 77.3 87.2 86.5
Nurses 90.7 90.1 91.7 88.7 90.4 87.6 85.1 92.0 90.2
Source: Attachment tables 11A.73-11A.88.
ED doctors, specialists or nurses always or often spent enough time with them
  NSW Vic Qld WA SA Tas ACT NT Aust
Doctors / specialists 81.5 80.4 81.3 81.3 81.7 77.9 75.3 85.0 81.0
Nurses 85.9 86.0 86.7 85.5 84.9 79.7 82.5 94.2 85.8
Source: Attachment tables 11A.73-11A.88.
Proportion (%) of persons who were admitted to hospital in the last 12 months reporting:
Hospital doctors, specialists or nurses always or often listened carefully to them
  NSW Vic Qld WA SA Tas ACT NT Aust
Doctors / specialists 91.3 90.5 88.4 90.0 93.6 88.5 83.9 91.0 90.6
Nurses 92.3 92.5 90.1 91.3 91.4 88.5 83.9 91.3 91.5
Source: Attachment tables 11A.73-11A.88.
Hospital doctors, specialists or nurses always or often showed respect to them
  NSW Vic Qld WA SA Tas ACT NT Aust
Doctors / specialists 92.7 93.0 90.3 91.2 96.0 89.5 84.8 91.8 92.4
Nurses 94.0 93.3 91.4 91.5 92.9 90.9 83.9 94.2 92.6
Source: Attachment tables 11A.73-11A.88.
Hospital doctors, specialists or nurses always or often spent enough time with them
  NSW Vic Qld WA SA Tas ACT NT Aust
Doctors / specialists 87.7 88.4 86.1 86.9 92.3 84.7 79.1 92.3 87.7
Nurses 88.6 91.2 87.2 88.4 88.9 86.2 81.9 94.2 89.0
Source: Attachment tables 11A.73-11A.88.

Sentinel events, 2012-13

Most recent data for this indicator are complete but not directly comparable (chapter 11). Data are available in tables 11A.89-11A.97.

Maternity services

An overview of the Maternity services performance indicator results are presented. Information to assist the interpretation of these data can be found in the indicator interpretation boxes in the Public hospitals chapter and attachment tables.

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Effectiveness — Appropriateness indicators

Caesareans for selected primiparae

Most recent data for this indicator not complete or not directly comparable (chapter 11).

Proportion (%) of births that were caesareans, 2013
  NSW Vic Qld WA SA Tas ACT NT Aust
% 23.2 24.9 22.8 24.8 27.3 na 24.3 30.4 24.2
Source: Attachment tables 11A.102-11A.112.

Inductions for selected primiparae

Most recent data for this indicator not complete or not directly comparable (chapter 11).

Proportion (%) of births that were induced, rate, 2013
  NSW Vic Qld WA SA Tas ACT NT Aust
% 39.4 34.6 29.9 35.9 41.6 na 29.6 35.7 35.8
Legend: na Not available.
Source: Attachment tables 11A.102-11A.112.

Instrumental vaginal births

Most recent data for this indicator are complete and comparable (chapter 11).

Instrumental vaginal births, 2012
  NSW Vic Qld WA SA Tas ACT NT Aust
% 22.7 28.2 21.7 30.2 24.5 26.1 27.4 18.7 11.9
Source: Attachment tables 11A.102-11A.112.

Vaginal birth after caesarean section

Most recent data for this indicator are complete and comparable (chapter 11).

Vaginal birth after caesarean section, 2012
  NSW Vic Qld WA SA Tas ACT NT Aust
Non-instrumental 12.5 11.6 12.3 9.1 12.4 12.2 12.2 18.7 11.9
Instrumental 3.8 4.3 2.9 3.0 3.7 3.4 5.9 3.5 3.7
Source: Attachment tables 11A.102-11A.112.

Effectiveness — Quality — Safety indicators

Perineal status after vaginal birth

Most recent data for this indicator are complete and comparable (chapter 11).

Mothers with third or fourth degree lacerations after vaginal births, 2012
  NSW Vic Qld WA SA Tas ACT NT Aust
% 2.0 1.9 2.0 2.3 2.3 1.6 4.1 2.8 2.1
Source: Attachment table 11A.113.

Efficiency indicators

Recurrent cost per maternity separation

Most recent data for this indicator are complete but not directly comparable (chapter 11).

Cost per maternity separation, without complications, dollars, 2011-12
  NSW Vic Qld WA SA Tas ACT NT Aust
Caesarean 8848 7889 9651 13 675 10 712 7746 12 936 15 333 9546
Vaginal delivery 4975 3634 4900 6499 4911 4050 5706 7503 4826
Source: Attachment tables 11A.114-11A.115.

Mother's average length of stay

Most recent data for this indicator are complete and comparable (chapter 11).

Mother's average length of stay, days, 2012-13
  NSW Vic Qld WA SA Tas ACT NT Aust
Caesarean 3.8 3.7 3.3 3.7 4.0 3.8 3.8 4.4 3.7
Vaginal delivery 1.8 1.8 1.5 1.7 1.7 1.8 1.4 2.1 1.7
Source: Attachment tables 11A.114-11A.115.

Outcome indicators

Baby's Apgar score at 5 minutes

Most recent data for this indicator are not complete and are not directly comparable (chapter 11).

Percentage of live births with an Apgar score of 3 or lower by birthweight, 2013
  NSW Vic Qld WA SA Tas ACT NT Aust
<1500g 15.1 18.7 18.6 5.4 8.0 na 13.8 26.0 na
1500-1999g 1.7 1.3 1.5 1.1 0.6 na 1.4 np na
2000-2499g 0.8 0.3 0.6 0.6 0.6 na 1.0 np na
2500g+ 0.3 0.2 0.2 0.2 0.1 na 0.3 0.4 na
Legend: na Not available; np Not published.
Source: Attachment tables 11A.116-11A.121.

Perinatal death rate

Most recent data for this indicator are not complete but are comparable (chapter 11)

Perinatal death rates — deaths per '000 total births, 2012
  NSW Vic Qld WA SA Tas ACT NT Aust
Fetal deaths 5.2 5.6 7.0 7.1 3.5 7.2 7.5 5.6 5.9
Neonatal deaths 2.3 2.1 3.0 1.4 2.4 2.9 2.6 3.9 2.3
Perinatal deaths 7.5 7.7 10.0 8.4 5.9 10.1 10.0 9.4 8.2
Source: Attachment tables 11A.116-11A.121.