Hospitals are very diverse in location, size and the services provided. In 2017–18, there were 693 public hospitals in Australia. The most recent data from 2016–17 show that there were 657 private hospitals (including day hospital facilities) (ABS 2018).

During 2017–18, a total of $74.0 billion was spent on Australia’s public and private hospitals with $30.8 billion (42%) of this funded by state and territory governments and $26.5 billion (36%) by the Australian Government. The remaining $16.7 billion (23%) came from non-government sources. Spending per person increased by an average of 2.1% per year between 2013–14 and 2017–18 after adjusting for inflation (2.2% for public hospital care and 2.0% for private). See Health expenditure.

Both public and private hospital sectors provide services for admitted and non-admitted patients (outpatient clinics and emergency department care).

Admitted patient services

Admitted patient services, or hospitalisations, are provided when a patient is formally admitted to a hospital. Hospitalisations can either be on the same day or involve a stay in hospital of 1 or more nights. A hospitalisation may be for medical, surgical, or other acute care, childbirth, mental health care, subacute care (for example rehabilitation or palliative care) or non-acute care (for example, maintenance care for a person suffering limitations due to a health condition). Some admitted patient services can also be provided via ‘hospital-in-the-home’ programs, where patients receive admitted care in a combination of in and outside the hospital settings.

In 2017–18, there were 62,000 beds in public hospitals in Australia. The number of hospital beds increased by 1.3% per year between 2013–14 and 2017–18. This trend coincided with a decrease in the average length of stay over time (an average of 2.2% decline per year), meaning fewer beds are used to support more episodes of care. The number of public hospital beds per 1,000 population was relatively stable between 2013–14 and 2017–18, ranging between 2.5 and 2.6 beds per 1,000 population.

The most recent data, from 2016–17, show that there were 34,000 hospital beds in private hospitals (including day hospital facilities)—a rate of 1.4 beds per 1,000 population, up from 1.3 beds per 1,000 population in 2012–13 (ABS 2018). The average decrease per year in the average length of stay over this period was 1.2%.

In 2018–19, there were 11.5 million hospitalisations—6.9 million in public hospitals and 4.6 million in private hospitals. Between 2014–15 and 2018–19, the total number of hospitalisations increased by an average of 3.3%—faster than the average population growth of 1.6% over the same period. Hospitalisations increased by an average of 3.7% each year in public hospitals and 2.6% in private hospitals.

In 2018–19, 33% of all hospitalisations 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% of all hospitalisations, and 11% of hospitalisations were overnight or longer in a private hospital.

The average length of stay in hospital is decreasing; between 2014–15 and 2018–19, the average length of stay in hospital decreased from 2.8 days to 2.7 days. The average length of stay in hospital was longer in public hospitals, at 3.0 days, and was 2.2 days in private hospitals in 2018–19. This difference in average length of stay is influenced by the differing patient characteristics, illnesses and procedures in public and private hospitals as well as differing administrative and clinical practices.

Why do people go to hospital?

The reason that a patient was admitted to hospital can be described in various ways, including the mode and urgency of admission, the type of care required or the principal diagnosis. The principal diagnosis is the diagnosis established after study (for example, at the completion of the hospitalisation) to be chiefly responsible for the episode of admitted patient care. Diagnoses are categorised using the International Statistical Classification of Diseases and Related Health problems, 10th Revision, Australian Modification (ICD-10-AM).

Overall, the most common reason a patient is admitted to hospital is for Other factors influencing health status. Other factors influencing health status includes examinations, investigations, observation, evaluation, screening, immunisation and other health management. The most common reason for admission to hospital varies with age and sex. The visualisation below presents the 5 most common reasons for a stay in hospital for males and females by age group, according to the patients’ principal diagnosis (Figure 1).

In 2018–19:

  • patients aged under 5 often stayed in hospital for Respiratory system issues and Perinatal period conditions following birth
  • patients aged 5–14 primarily stayed in hospital for Injury and poisoning, and Digestive system diseases. Males aged 15–24 also stayed in hospital for the same reasons, whereas females of this age group mostly stayed for pregnancy and childbirth-related reasons, as well as Digestive system diseases
  • similar to the age group before them, females aged 25–44 predominantly stayed in hospital for pregnancy and childbirth, whereas males of that age stayed in hospital for Other factors influencing health status
  • patients aged 45–64 stayed in hospital for Other factors influencing health status and Digestive system diseases
  • male patients aged 65 and over primarily came to hospital for Other factors influencing health status and Neoplasms (cancer). Female patients aged 65 and over primarily came to hospital for Other factors influencing health status and Musculoskeletal system diseases.
     

This figure shows that the most common reasons for a stay in hospital for male and female patients by ascending age group were Respiratory system issues, Injury and poisoning, Digestive system diseases, Pregnancy, childbirth and the puerperium, and Health status factors and contact with health services.

Elective surgery

Surgery that is planned and can be booked in advance is classified as elective surgery. Note that the data presented here does not include the time period when some elective surgeries were temporarily postponed due to COVID-19. 

In 2018–19:

  • around 2.3 million elective admissions involved surgery, with 66% (more than 1.5 million) of these occurring in private hospitals
  • people living in Very remote areas were least likely to have an elective admission involving surgery
  • people living in areas classified as being in the lowest (most disadvantaged) socioeconomic areas had lower rates of elective admissions involving surgery than people living in areas classified as being in the highest (least disadvantaged) areas.

Elective surgery waiting times in public hospitals

Information on elective surgery waiting times is available only for patients who were admitted from public hospital waiting lists. These patients are assessed clinically by a surgeon, who determines the urgency of their need for surgery, before being placed on a waiting list. Waiting time for elective surgery is calculated from the time a patient is placed on the waiting list until they are admitted for surgery.

In 2018–19, 893,000 patients were added to public hospital elective surgery waiting lists. Between 2014–15 and 2018–19 the number of patients added increased by an average of 2.5% per year. About 758,000 patients were admitted from public hospital elective surgery waiting lists in the same year. Between 2014–15 and 2018–19, the number of admissions from public hospital elective surgery waiting lists increased by an average of 2.1% each year.

The median waiting time for public hospital elective surgery in 2018–19 was 41 days. That is, 50% of patients were admitted for their awaited procedure within 41 days. This is an increase from a median waiting time of 35 days in 2014–15 (Figure 2).
 

This chart shows that the elective surgery waiting times by selected surgical procedure varies by state and territory, but has remained fairly constant for the whole of Australia over the past 5 years.

Non-admitted patient services

Non-admitted patient care includes care provided in emergency departments and outpatient clinics. Public hospitals provide the majority of non-admitted patient services.

The activities not included in this section are the dispensing of medicines to patients not admitted to the hospital, district nursing services, some community health services provided by hospitals, and patients admitted to hospital from emergency departments.

Outpatient clinics

In outpatient clinics, patients consult specialist medical practitioners, have diagnostic services or other procedures, or are provided with allied health or specialist nursing care—without being admitted to hospital.

In 2017–18, 39 million outpatient clinic service events were reported for 601 public hospitals and 29 other services that provided outpatient care for public patients on behalf of a public hospital.

Emergency departments

Emergency departments are a critical part of Australia’s health care system, providing care for patients who require urgent medical, surgical or other attention. Most larger public hospitals have purpose-built emergency departments. Some smaller public hospitals can provide emergency services through informal arrangements. Accident and emergency services can also be provided by private hospitals, but national data are available only for public hospital emergency departments.  

Emergency department presentations

In 2018–19, there were 8.4 million presentations to public hospital emergency departments. This was an average of more than 23,000 each day across Australia. Between 2014–15 and 2018–19, the number of emergency department presentations increased by an average of 3.2% each year.

In 2018–19:

  • patients aged under 5 (11%) and patients aged 65 and over (22%) were over-represented in emergency department presentations, compared with the overall population
  • among patients aged 0–14, more boys than girls presented to emergency departments (56% and 44%, respectively)
  • 26% of patients arrived by ambulance, air ambulance or helicopter rescue service.

Emergency department waiting times

Emergency department waiting time is the time elapsed from presentation in the emergency department to commencement of clinical care. In 2018–19, nationally, 50% of patients had been seen within 19 minutes; 90% were seen within 100 minutes.

A patient is said to be ‘seen on time’ if the time between presentation at the emergency department and the commencement of their clinical care is within the time specified by the triage category they are assigned.

Figure 3: Measurement of time patients spend in emergency departments

This graphic represents the progress of a patient through the emergency department.  The time points in order are: presentation in the emergency department; triage category assigned; commencement of clinical care; clinical care ends; and physical departure.

In 2018–19, about 71% of emergency department presentations were seen on time, including:

  • almost 100% of Resuscitation patients (within 2 minutes)
  • 75% of Emergency patients (within 10 minutes)
  • 63% of Urgent patients (within 30 minutes)
  • 73% of Semi-urgent patients (within 60 minutes)
  • 91% for Non-urgent patients (within 120 minutes).

The proportion of emergency department presentations that were seen on time decreased from 74% in 2014–15 to 71% in 2018–19 (Figure 4).
 

This chart shows that the proportion of patients seen on time and proportion who completed their emergency department stay within 4 hours varies by state and territory, and has gone down slighty for the whole of Australia over the past 5 years.