Report on Government Services 2020

Public hospitals provide a range of services, including:

• acute care services to admitted patients
• subacute and non-acute services to admitted patients (for example, rehabilitation, palliative care and long stay maintenance care)
• emergency, outpatient and other services to non-admitted patients
• mental health services, including services provided to admitted patients by designated psychiatric/psychogeriatric units
• public health services
• teaching and research activities.

This section focuses on services (acute, subacute and non-acute) provided to admitted patients and services provided to non-admitted patients in public hospitals. These services comprise the bulk of public hospital activity.

In some instances, data for stand-alone psychiatric hospitals are included in this section. The performance of psychiatric hospitals and psychiatric units of public hospitals is examined more closely in the ‘Mental health management’ section of this Report (section 13).

Total recurrent expenditure on public hospitals (excluding depreciation) was $67.2 billion in 2017‑18 (table 12A.1), with 91 per cent funded by the Australian, State and Territory governments and 9 per cent funded by non-government sources (including depreciation) (AIHW 2019b).

Government real recurrent expenditure (all sources) on public hospitals per person was $2706 in 2017‑18; an increase on 2016-17 ($2673, table 12A.2).

Hospitals

In 2017‑18, Australia had 693 public hospitals – 2 fewer than 2016‑17 (table 12A.3). Although 68.3 per cent of hospitals had 50 or fewer beds (figure 12.1), these smaller hospitals represented only 13.1 per cent of total available beds (table 12A.3).

Hospital beds

There were 62 243 available beds for admitted patients in public hospitals in 2017‑18, equivalent to 2.6 beds per 1000 people (tables 12A.3–4). The concept of an available bed is becoming less important in the overall context of hospital activity, particularly given the increasing significance of same day hospitalisations and hospital-in-the-home (AIHW 2011). Nationally, the number of beds available per 1000 people increased as remoteness increased (table 12A.4).

Admitted patient care

There were approximately 6.7 million separations from public (non-psychiatric) hospitals in 2017‑18, of which just over half were same day patients (table 12A.5). Nationally, this equates to 253.9 separations per 1000 people (figure 12.2). Acute care separations accounted for 94.0 per cent of separations from public hospitals (table 12A.10).

Variations in admission rates can reflect different practices in classifying patients as either admitted same day patients or non-admitted outpatients. The extent of differences in classification practices can be inferred from the variation in the proportion of same day separations across jurisdictions for certain conditions or treatments. This is particularly true of medical separations, where there was significant variation across jurisdictions in the proportion of same day medical separations in 2017-18 (table 12A.7).

In 2017-18, on an age-standardised basis, public hospital separation rates for Aboriginal and Torres Strait Islander Australians were markedly higher than the corresponding rates for all Australians. For private hospital separations, rates were higher for all Australians compared to Aboriginal and Torres Strait Islander Australians (though separations are lower for private hospitals compared to public hospitals) (table 12A.8).

Non-admitted patient services

Non-admitted patient services include outpatient services, which may be provided on an individual or group basis, and emergency department services. A total of 37.7 million individual service events were provided to outpatients in public hospitals in 2017‑18 and around 1.3 million group service events (table 12A.11). Differing admission practices across states and territories lead to variation among jurisdictions in the services reported (AIHW 2019d). There were 8.0 million presentations to emergency departments in 2017‑18 (table 12A.12).

Staff

In 2017‑18, nurses comprised the single largest group of full time equivalent (FTE) staff employed in public hospitals (figure 12.3). Comparing data on FTE staff across jurisdictions should be undertaken with care, as these data are affected by jurisdictional differences in the recording and classification of staff.

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2018, Annual Report 2017‑18, ACSQHC, Sydney.

AIHW (Australian Institute of Health and Welfare) 2011, Australian Hospital Statistics 2009‑10, Health Services Series No. 40, Cat. no. HSE 107 AIHW, Canberra.

—— 2019a, Elective surgery waiting times 2018‑19: Australian hospital statistics, AIHW, Canberra, https://www.aihw.gov.au/reports-data/myhospitals/sectors/elective-surgery (accessed 11 December 2019).

—— 2019b, Health expenditure Australia 2017‑18, Health and Welfare Expenditure Series No. 65, Cat. no. HWE 77 AIHW, Canberra.

—— 2019c, Hospital resources 2017‑18: Australian hospital statistics, Health services series, AIHW, Canberra, https://www.aihw.gov.au/reports/hospitals/hospital-resources-2017-18-ahs/data (accessed 15 October 2019).

—— 2019d, Non-admitted patient care 2017‑18: Australian hospital statistics, Health services series, AIHW, Canberra, https://www.aihw.gov.au/reports/hospitals/non-admitted-patient-care-2017-18-ahs/contents/at-a-glance (accessed 15 October 2019).