Report on Government Services 2023

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 ‘Services for mental health’ section of this Report (section 13).

Total recurrent expenditure on public hospitals (excluding depreciation) was $81.6 billion in 2020‑21 (table 12A.1), with 93 per cent funded by the Australian, State and Territory governments and 7 per cent funded by non-government sources (including depreciation) (AIHW 2022).

Government real recurrent expenditure (all sources) on public hospitals per person was $3166 in 2020‑21; an increase of 4.2 per cent from 2019-20 ($3037) (table 12A.2).

Hospitals

In 2020‑21, Australia had 697 public hospitals – 2 more than 2019‑20 (table 12A.3). Although 68.4 per cent of hospitals had 50 or fewer beds (figure 12.1), these smaller hospitals represented only 12.8 per cent of total available beds (table 12A.3).

Hospital beds

There were 63 333 available beds for admitted patients in public hospitals in 2020‑21, equivalent to 2.5 beds per 1000 people (table 12.1 and 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 2022a; Montalto et al 2020). Nationally, the number of beds available per 1000 people increased as remoteness increased (table 12A.4).

Admitted patient care

There were approximately 7.0 million separations from public (non-psychiatric) hospitals in 2020‑21, of which just over half (55.5 per cent) were same day patients (table 12A.5). Nationally, this equates to 247.9 separations per 1000 people (figure 12.2). Acute care separations accounted for 94.1 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 2020-21 (table 12A.7).

In 2020-21, on an age-standardised basis, public hospital separation rates for Aboriginal and Torres Strait Islander people were markedly higher than the corresponding rates for all people. For private hospital separations, rates were higher for all people compared to Aboriginal and Torres Strait Islander people (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. Nationally, in 2020-21, 46.2 million individual service events were provided to outpatients in public hospitals (a 24.2 per cent increase on 2019-20) and 637 443 group service events (a 33.5 per cent decrease on 2019-20) (table 12A.11). Differing admission practices across states and territories lead to variation among jurisdictions in the services reported (AIHW 2022b). There were 8.8 million presentations to emergency departments in 2021‑22 (table 12A.12).

Staff

In 2020‑21, 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 recording and classifying staff.

‘Equity of access by selected equity groups’ is an indicator of governments’ objective to provide hospital services in an equitable manner.

‘Equity of access by selected equity groups’ is measured for the selected equity group of people living in remote and very remote areas and is defined as the percentage of people who delayed going to hospital due to distance from hospital, by region.

Similar rates across regions can indicate equity of access to hospital services across regions.

Data are not yet available for reporting against this measure.

‘Emergency department waiting times’ is an indicator of governments’ objective to provide timely and accessible services to all.

‘Emergency department waiting times’ is defined by the following two measures:

• Emergency department waiting times by triage category, defined as the proportion of patients seen within the benchmarks set by the Australasian Triage Scale. The Australasian Triage Scale is a scale for rating clinical urgency, designed for use in hospital-based emergency services in Australia and New Zealand. The benchmarks, set according to triage category, are as follows:
  • triage category 1: need for resuscitation — patients seen immediately
  • triage category 2: emergency — patients seen within 10 minutes
  • triage category 3: urgent — patients seen within 30 minutes
  • triage category 4: semi-urgent — patients seen within 60 minutes
  • triage category 5: non-urgent — patients seen within 120 minutes.
• Proportion of patients staying for four hours or less, defined as the proportion of presentations to public hospital emergency departments where the time from presentation to admission, transfer or discharge is less than or equal to four hours. It is a measure of the duration of the emergency department service rather than a waiting time for emergency department care.

High or increasing proportions for both measures are desirable.

The comparability of emergency department waiting times data across jurisdictions can be influenced by differences in data coverage and clinical practices — in particular, the allocation of cases to urgency categories. The proportion of patients in each triage category who were subsequently admitted can indicate the comparability of triage categorisations across jurisdictions and thus the comparability of the waiting times data (table 12A.13).

Measure 1: In 2021-22, all category 1 patients were seen within clinically appropriate timeframes, except in SA and Tasmania. For all triage categories combined, an estimated 67 per cent of patients were seen within triage category timeframes (table 12.2).

Measure 2: The proportion of patients staying for four hours or less in an emergency department was 60.9 per cent in 2021-22, continuing an annual decrease from 73.2 per cent in 2015-16 (figure 12.4).

‘Waiting times for admitted patient services’ is an indicator of governments’ objective to provide timely and accessible services to all.

‘Waiting times for admitted patient services’ is defined by the following three measures:

• Overall elective surgery waiting times
• Elective surgery waiting times by clinical urgency category
• Presentations to emergency departments with a length of stay of 4 hours or less ending in admission.

Overall elective surgery waiting times

‘Overall elective surgery waiting times’ are calculated by comparing the date patients are added to a waiting list with the date they were admitted. Days on which the patient was not ready for care are excluded. Overall waiting times are presented as the number of days within which 50 per cent of patients are admitted and the number of days within which 90 per cent of patients are admitted. Patients on waiting lists who were not subsequently admitted are excluded.

For overall elective surgery waiting times, a low or decreasing number of days waited is desirable. Comparisons across jurisdictions should be made with caution, due to differences in clinical practices and classification of patients across Australia. The measures are also affected by variations across jurisdictions in the method used to calculate waiting times for patients who transferred from a waiting list managed by one hospital to a waiting list managed by another hospital, with the time waited on the first list included in the waiting time reported in NSW, WA, SA and the NT. This approach can have the effect of increasing the apparent waiting times for admissions in these jurisdictions compared with other jurisdictions.

Measure 1: Nationally in 2021-22, 50 per cent of patients were admitted within 40 days (down from 48 days in 2020-21) and 90 per cent of patients were admitted within 323 days (down from 348 days in 2020-21) (figure 12.5). Data are available on elective surgery waiting times by hospital peer group and indicator procedure, Aboriginal and Torres Strait Islander status, remoteness and socioeconomic status (tables 12A.19–22).

Elective surgery waiting times by clinical urgency category

‘Elective surgery waiting times by clinical urgency category’ reports the proportion of patients who were admitted from waiting lists after an extended wait. When patients are placed on public hospital waiting lists, clinical assessments are made on how urgently they require elective surgery. The clinical urgency categories are:

• Category 1 — procedures that are clinically indicated within 30 days
• Category 2 — procedures that are clinically indicated within 90 days
• Category 3 — procedures that are clinically indicated within 365 days.

The term ‘extended wait’ is used for patients in categories 1, 2 and 3 waiting longer than specified times (30 days, 90 days and 365 days respectively).

For elective surgery waiting times by clinical urgency category, a low or decreasing proportion of patients who experienced extended waits at admission is desirable. However, variation in the way patients are classified to urgency categories should be considered. Rather than comparing jurisdictions, the results for individual jurisdictions should be viewed in the context of the proportions of patients assigned to each of the three urgency categories.

Measure 2: Jurisdictional differences in the classification of patients by urgency category are shown in table 12.3a. The proportions of patients on waiting lists who already had an extended wait at the date of assessment are reported in tables 12A.24–31.

Presentations to emergency departments with a length of stay of 4 hours or less ending in admission

‘Presentations to emergency departments with a length of stay of 4 hours or less ending in admission’ is defined as the proportion of presentations to public hospital emergency departments where the time from presentation to admission to hospital is less than or equal to 4 hours.

A high or increasing proportion of presentations to emergency departments with a length of stay of 4 hours or less ending in admission is desirable.

Measure 3: Nationally in 2021-22, 34 per cent of people who presented to an emergency department and were admitted, waited 4 hours or less to be admitted to a public hospital (table 12.3b). This proportion has declined each year over the 5 years of reported data.

‘Elective surgery waiting list turn over’ is an indicator of governments' objective to provide timely and accessible services to all.

‘Elective surgery waiting list turn over’ is defined as the number of additions to, and removals from, public hospital elective surgery waiting lists. It is measured as the number of people removed from public hospital elective surgery waiting lists following admission for surgery during the reference year, divided by the number of people added to public hospital elective surgery waiting lists during the same year, multiplied by 100.

The number of people removed from public hospital elective surgery waiting lists following admission for surgery includes elective and emergency admissions. For context, the total number of removals from elective surgery waiting lists are also reported. Other reasons for removal include patient not contactable or died, patient treated elsewhere, surgery not required or declined, transferred to another hospital's waiting list, and not reported.

When interpreting these data, 100 per cent indicates that an equal number of patients were added to public hospital elective surgery waiting lists as were removed following admission for surgery during the reporting period (therefore the number of patients on the waiting list will be largely unchanged). A figure less than 100 per cent indicates that more patients were added to public hospital elective surgery waiting lists than were removed following admission for surgery during the reporting period (therefore the number of patients on the waiting list will have increased).

A higher and increasing per cent of patient turn over is desirable as it indicates the public hospital system is keeping pace with demand for elective surgery.

Nationally in 2021-22, 783 715 people were added to public hospital elective surgery waiting lists, while 622 988 people were removed following admission for surgery, resulting in a national public hospital elective surgery waiting list turn over of 79.5 per cent (table 12.4). Results varied across jurisdictions.

'Appropriateness of hospital services’ is an indicator of governments’ objective to provide care that is appropriate and responsive to the needs of individuals throughout their lifespan and communities.

'Appropriateness of hospital services’ is defined as the proportion of patients who discharge against medical advice and is measured as:

• Emergency department presentations:
  • patients who did not wait, as a proportion of all emergency department presentations
  • patients who left at their own risk, as a proportion of all emergency department presentations
• Admitted patient care separations:
  • patients who left or were discharged against medical advice, as a proportion of all hospital separations.

'Did not wait' refers to patients who did not wait for clinical care to commence or medical assessment following triage in the emergency department. 'Left at own risk' refers to patients who left against advice after treatment had commenced. This includes patients who were planned for admission but who did not physically leave the emergency department prior to departing. 'Discharge against medical advice' refers to patients who were admitted to hospital and left against the advice of their treating physician.

Patients who do not wait, leave at own risk and discharge against medical advice are at an increased risk of complications, readmission and mortality. Low or decreasing proportions of patients who do not wait, leave at own risk and discharge against medical advice are desirable.

Broader, system-level definitions of appropriate health care include dimensions such as evidence-based care, variations in clinical practice and resource use. Additional measures for this indicator will be considered for inclusion in future editions of this Report.

Nationally in 2020-21, 3.8 per cent of emergency department presentations did not wait, while 2.3 per cent of emergency department presentations left at their own risk. Additionally, 1.2 per cent of admitted patients left or were discharged against medical advice (table 12.5). Proportions for all measures were higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people (table 12A.34).

‘Accreditation’ is an indicator of governments’ objective to provide public hospital services that are high quality and safe.

‘Accreditation’ is defined as public hospitals accredited to the National Safety and Quality Health Service Standards (the Standards) and is measured as:

• the number of public hospitals accredited, as a proportion of all public hospitals assessed for accreditation in the same calendar year
• the number of public hospitals accredited during the calendar year that required remedial actions to achieve accreditation, as a proportion of all public hospitals accredited during the same calendar year.

It is mandatory for all hospitals and day procedure services to be accredited to the Standards. Health service organisations must demonstrate that they meet all requirements in the Standards to achieve accreditation. Reaccreditation against the Standards is required every three years. The standards are:

• Clinical governance
• Partnering with consumers
• Preventing and controlling infections
• Medication safety
• Comprehensive care
• Communicating for safety
• Blood management
• Recognising and responding to acute deterioration.

A high or increasing rate of accreditation is desirable. Accreditation against the Standards is evidence that a hospital has been able to demonstrate compliance with the Standards. It does not mean that an accredited hospital will always provide high quality and safe care.

There are differences across jurisdictions in: (1) the proportion of public hospitals opting for announced or short-notice assessments (from 2023, short-notice assessments will be mandatory); and (2) the mix of hospitals that were assessed (for example, large metropolitan hospitals and small rural services). This indicator should be interpreted in conjunction with other indicators of public hospital quality and safety.

Nationally in 2021, 38 per cent of public hospitals that were accredited during the year required remedial actions to achieve accreditation (table 12.6). This is higher than the proportion in 2020. However, due to the temporary suspension of the national accreditation program between March 2020 and October 2021 as a result of COVID-19, fewer hospitals were accredited in 2020 (33 hospitals) compared to 2021 (207 hospitals) (table 12A.35). During this period of temporary program suspension, hospitals and day procedure services maintained their existing accreditation status (ACSQHC 2020).

‘Adverse events in public hospitals’ is an indicator of governments’ objective to provide public hospital services that are high quality and safe. Sentinel events, which are a subset of adverse events that result in death or very serious harm to the patient, are reported as a separate output indicator.

‘Adverse events in public hospitals’ is defined by three measures:

• Selected healthcare-associated infections
• Adverse events treated in hospitals
• Falls resulting in patient harm in hospitals.

Selected healthcare-associated infections

‘Selected healthcare-associated infections’ is the number of Staphylococcus aureus (including Methicillin-resistant Staphylococcus aureus [MRSA]) bacteraemia (SAB) patient episodes associated with public hospitals (admitted and non-admitted patients), expressed as a rate per 10 000 patient days for public hospitals.

A patient episode of SAB is defined as a positive blood culture for SAB. Only the first isolate per patient is counted, unless at least 14 days has passed without a positive blood culture, after which an additional episode is recorded.

SAB is considered to be healthcare-associated if the first positive blood culture is collected more than 48 hours after hospital admission or less than 48 hours after discharge, or if the first positive blood culture is collected less than or equal to 48 hours after admission to hospital and the patient episode of SAB meets at least one of the following criteria:

• SAB is a complication of the presence of an indwelling medical device
• SAB occurs within 30 days of a surgical procedure where the SAB is related to the surgical site
• SAB was diagnosed within 48 hours of a related invasive instrumentation or incision
• SAB is associated with neutropenia contributed to by cytotoxic therapy. Neutropenia is defined as at least two separate calendar days with values of absolute neutrophil count (ANC) or total white blood cell count <500 cell/mm³ (0.5 × 10⁹/L) on or within a seven-day time period which includes the date the positive blood specimen was collected (Day 1), the three calendar days before and the three calendar days after.

Cases where a known previous positive test was obtained within the past 14 days are excluded. Patient days for unqualified newborns, hospital boarders and posthumous organ procurement are excluded.

A low or decreasing rate of selected healthcare-associated infections is desirable.

Measure 1: Nationally in 2021-22, the rate of selected healthcare-associated infections was 0.7 per 10 000 patient days (figure 12.6a).

Adverse events treated in hospitals

‘Adverse events treated in hospitals’ are incidents in which harm resulted to a person during hospitalisation and are measured by separations that had an adverse event (including infections, falls resulting in injuries and problems with medication and medical devices) that occurred during hospitalisation. Hospital separations data include information on diagnoses and place of occurrence that can indicate that an adverse event was treated and/or occurred during the hospitalisation, but some adverse events are not identifiable using these codes.

Low or decreasing adverse events treated in hospitals are desirable.

Measure 2: Nationally in 2020-21, 6.6 per cent of separations in public hospitals had an adverse event reported during hospitalisation (table 12.7). Results by category (diagnosis, external cause and place of occurrence of the injury or poisoning) are in table 12A.37.

Falls resulting in patient harm in hospitals

‘Falls resulting in patient harm in hospitals’ is defined as the number of separations with an external cause code for fall and a place of occurrence of health service area, expressed as a rate per 1000 hospital separations. It is not possible to determine if the place of occurrence was a public hospital, only that it was a health service area.

A low or decreasing rate of falls resulting in patient harm in hospitals is desirable.

Measure 3: Nationally in 2020-21, the rate of falls resulting in patient harm was 5.5 per 1000 hospital separations; results varied across states and territories (figure 12.6b). Data are reported by Indigenous status and remoteness in table 12A.38.

‘Sentinel events’ is an indicator of governments’ objective to deliver public hospital services that are high quality and safe. Sentinel events are a subset of adverse events that result in death or very serious harm to a patient. Adverse events are reported as a separate output indicator.

‘Sentinel events’ is defined as the number of reported adverse events that occur because of hospital system and process deficiencies, and which result in the death of, or serious harm to, a patient. Sentinel events occur relatively infrequently and are independent of a patient’s condition.

Australian health ministers agreed version 2 of the Australian sentinel events list in December 2018. All jurisdictions implemented these categories on 1 July 2019. The national sentinel events are:

• Surgery or other invasive procedure performed on the wrong site resulting in serious harm or death
• Surgery or other invasive procedure performed on the wrong patient resulting in serious harm or death
• Wrong surgical or other invasive procedure performed on a patient resulting in serious harm or death
• Unintended retention of a foreign object in a patient after surgery or other invasive procedure resulting in serious harm or death
• Haemolytic blood transfusion reaction resulting from ABO blood type incompatibility resulting in serious harm or death
• Suspected suicide of a patient in an acute psychiatric unit or acute psychiatric ward
• Medication error resulting in serious harm or death
• Use of physical or mechanical restraint resulting in serious harm or death
• Discharge or release of an infant or child to an unauthorised person
• Use of an incorrectly positioned oro-or naso-gastric tube resulting in serious harm or death.

A low or decreasing number of sentinel events is desirable.

All state and territory governments have implemented sentinel event reporting programs. The purpose of these programs is to facilitate a safe environment for patients by reducing the frequency of these events. The programs are not punitive and are designed to facilitate self‑reporting of errors so that the underlying causes of events can be examined, and action taken to reduce the risk of these events re-occurring.

Changes in the number of sentinel events reported over time do not necessarily mean that Australian public hospitals have become more or less safe, but might reflect improvements in incident reporting mechanisms, organisational cultural change, and/or an increasing number of hospital admissions (these data are reported as numbers rather than rates). Sentinel event should be monitored over time to identify trends and establish underlying reasons.

Nationally in 2020-21, there was a total of 82 sentinel events, 26 more than in 2019‑20 (table 12.8). As larger states and territories will tend to have more sentinel events than smaller jurisdictions, the numbers of separations are also presented to provide context. Data disaggregated by the type of sentinel event are reported in table 12A.39.

‘Patient satisfaction’ provides a proxy measure of governments’ objective to deliver services that are responsive to individuals throughout their lifespan and communities.

‘Patient satisfaction’ is defined by two measures:

• Proportion of people who went to an emergency department in the last 12 months for their own health reporting that the emergency department doctors, specialists or nurses ‘always’ or ‘often’:
  • listened carefully to them
  • showed respect to them
  • spent enough time with them
• Proportion of people who were admitted to hospital in the last 12 months reporting that the hospital doctors, specialists or nurses ‘always’ or ‘often’:
  • listened carefully to them
  • showed respect to them
  • spent enough time with them.

A high or increasing proportion of patients who were satisfied is desirable, as it suggests high quality hospital care that meets patient needs and expectations.

The ABS Patient Experience Survey of people aged 15 years and over does not include people living in discrete Indigenous communities, which affects the representativeness of the NT results. Approximately 20 per cent of the resident population of the NT live in discrete Indigenous communities.

Measure 1: Nationally in 2021-22, the rate of respondents across all areas reporting that hospital and emergency department doctors, specialists and nurses listened carefully, showed respect and spent enough time with them was above 80 per cent (figure 12.7a).

Measure 2: Nationally in 2021-22, the rate of respondents across all areas reporting that hospital doctors, specialists or nurses listened carefully, showed respect and spent enough time with them was above 86 per cent (figure 12.7b).

‘Continuity of care’ is an indicator of governments' objective to provide care that is well co‑ordinated where more than one service type, and/or ongoing service provision is required.

‘Continuity of care’ is defined by two measures:

• the number of hospital patients with complex needs for which a discharge plan is provided within 5 days of discharge divided by all hospital patients with complex care needs expressed as a rate per 1000 separations
• the proportion of patients who reported that arrangements were not made by their hospital for any services needed after leaving hospital when last admitted.

High or increasing rates of discharge plans provided to patients with complex care needs within 5 days is desirable. While it is desirable for discharge plans to be provided to patients, administrative data on the presence of a discharge plan does not provide any information on whether the discharge plan was carried out or whether it was effective in improving patient outcomes.

A low or decreasing proportion of patients reporting that arrangements were not made by their hospital for any services needed after leaving hospital when last admitted is desirable.

Data are not yet available for reporting against these measures. However, summary data from the 2016 ABS survey of health care are available to report as contextual information for measure 2 for people aged 45 years and over in table 12A.44.

‘Selected unplanned hospital readmission rates’ is an indicator of governments’ objective to provide public hospital services that are of high quality and well-coordinated to ensure continuity of care.

‘Selected unplanned hospital readmission rates’ is defined as the rate at which patients unexpectedly return to the same hospital within 28 days for further treatment where the original admission involved one of a selected set of procedures, and the readmission is identified as a post-operative complication. It is expressed as a rate per 1000 separations in which one of the selected surgical procedures was performed. The indicator is an underestimate of all possible unplanned/unexpected readmissions.

The selected surgical procedures are knee replacement, hip replacement, tonsillectomy and adenoidectomy, hysterectomy, prostatectomy, cataract surgery and appendectomy. Unplanned readmissions are those having a principal diagnosis of a post-operative adverse event for which a specified ICD-10-AM diagnosis code has been assigned.

Low or decreasing rates of unplanned readmissions are desirable. Conversely, high or increasing rates suggest the quality of care provided by hospitals, or post-discharge care or planning, should be examined, because there may be scope for improvement.

Of the selected surgical procedures in 2020-21, readmission rates were highest nationally, and for most jurisdictions, for tonsillectomy and adenoidectomy, with the rate increasing from 27.8 to 47.9 readmissions per 1000 separations over the past 10 years (table 12.9). Selected unplanned hospital readmission rates are reported by hospital peer group, Indigenous status, remoteness and socioeconomic status in table 12A.46.

‘Workforce sustainability’ is an indicator of governments’ objective to provide sustainable public hospital services.

‘Workforce sustainability’ reports age profiles for the nursing and midwifery workforce and the medical practitioner workforce. It shows the proportions of registered nurses and midwives, and medical practitioners in ten year age brackets, by jurisdiction and by region.

High or increasing proportions of the workforce that are new entrants and/or low or decreasing proportions of the workforce that are close to retirement are desirable.

All nurses, midwives and medical practitioners are included in these measures, as a crude indication of the potential nursing, midwifery and medical practitioner workforces for public hospitals.

Health workforce sustainability relates to the capacity of the health workforce to meet current and projected service demand. These measures are not a substitute for a full workforce analysis that allows for migration, trends in full-time work and expected demand increases. They can, however, indicate that further attention should be given to workforce sustainability for public hospitals.

Nationally in 2021, 12.1 per cent of the FTE nursing workforce were aged 60 years and over (figure 12.8a). This proportion has increased from 10.3 per cent in 2013 but may be partially offset by a corresponding increase in the proportion of the nursing workforce aged under 40 years (table 12A.47).

For the medical practitioner workforce, the proportion aged 60 years and over was 15.5 per cent in 2021 (figure 12.8b). Similar to the nursing workforce, the proportion of the medical practitioner workforce aged under 40 years has increased over this period (table 12A.49).

For both the nursing and medical practitioner workforce, the proportion aged 60 years and over is higher in remote areas compared to non-remote areas (tables 12A.47 and 12A.49).

‘Cost per admitted patient separation’ is an indicator of governments’ objective to deliver services in an efficient manner.

‘Cost per admitted patient separation’ is defined by the following two measures:

• Recurrent cost per weighted separation
• Capital cost per weighted separation.

A low or decreasing recurrent cost per weighted separation or capital cost per weighted separation can reflect more efficient service delivery in public hospitals. However, this indicator should be viewed in the context of the performance indicator framework as a whole, as decreasing cost could also be associated with decreasing quality and effectiveness.

Recurrent cost per weighted separation

‘Recurrent cost per weighted separation’ is the average cost of providing care for an admitted patient (overnight stay or same day) adjusted for casemix. Casemix adjustment takes account of variation in the relative complexity of a patient’s clinical condition and of the hospital services provided, but not other influences on length of stay.

Measure 1: Nationally in 2020-21, the recurrent cost per weighted separation was $5153, down from $5241 in 2019-20 (figure 12.9a). Data on the average cost per admitted patient separation are available on the subset of presentations that are acute emergency department presentations (table 12A.53).

Capital cost per weighted separation

‘Capital cost per weighted separation’ is calculated as the user cost of capital (calculated as 8 per cent of the value of non-current physical assets including buildings and equipment but excluding land) plus depreciation, divided by the number of weighted separations.

This measure allows the full cost of hospital services to be considered. Depreciation is defined as the cost of consuming an asset’s services. It is measured by the reduction in value of an asset over the financial year. The user cost of capital is the opportunity cost of the capital invested in an asset, and is equivalent to the return foregone from not using the funds to deliver other services or to retire debt. Interest payments represent a user cost of capital, so are deducted from capital costs to avoid double counting.

Measure 2: Costs associated with non-current physical assets are important components of the total costs of many services delivered by government agencies. Nationally in 2020-21, the total capital cost (excluding land) per weighted separation was $1275 (figure 12.9b).

‘Recurrent cost per non-admitted patient’ is an indicator of governments’ objective to deliver services in an efficient manner.

‘Recurrent cost per non-admitted patient’ is defined by the following two measures:

• Average cost per non-admitted acute emergency department presentation
• Average cost per non-admitted service event.

A low or decreasing recurrent cost per non-admitted patient can reflect more efficient service delivery in public hospitals. However, this indicator should be viewed in the context of the set of performance indicators as a whole, as decreasing cost could also be associated with decreasing quality and effectiveness. This indicator does not adjust for the complexity of service.

Measure 1: Nationally in 2020-21, the average cost per non-admitted emergency department presentation was $611 (figure 12.10a). Costs per non-admitted emergency department presentation have increased over the five years of reported data.

Measure 2: Nationally in 2020-21, the average cost per non-admitted service event was $330, down from $342 in 2019-20 (figure 12.10b).

‘Hospital mortality’ is an indicator of governments’ objective to alleviate or manage illness and the effects of injury and provide high quality and safe care.

‘Hospital mortality’ is defined as death in low-mortality diagnostic related groups (DRGs) expressed as a rate. Low-mortality DRGs comprise diagnoses that have a very low chance of death (for example, headache, hand procedures, arthroscopy).

Low or decreasing rates of death in low-mortality DRGs can indicate more effective management of illness and the effects of injury.

In 2009, Australian Health Ministers agreed state and territory hospital mortality data should be gathered and presented to hospitals for regular review. The hospital mortality indicators endorsed by Health Ministers include 'death in low mortality DRGs', 'hospital-standardised mortality ratios' and 'in-hospital mortality for four specified conditions' (acute myocardial infarction, stroke, fractured neck of femur and pneumonia) (ACSQHC 2014).

Hospital mortality indicators can act as screening tools to flag potential issues for further clinical review. Hospital mortality data should be considered as part of a suite of patient safety metrics including hospital-acquired infection, patient experience data and readmission rates.

Data are not yet available for reporting on this indicator. Table 12.10 provides an overview of the review mechanisms in place across states and territories for examining in-hospital deaths.

Sources: State and Territory governments (unpublished).