Summary

Access to elective surgery has been the subject of community discussion for many years. In general terms, access to elective surgery can be measured by considering how much elective surgery is supplied, or by considering the demand for elective surgery and the extent to which the demand differs from the supply. In the absence of very good measures, use of both supply-related measures and demand-related measures may be useful.

Current measures of access to public elective surgery are demand-related and have a number of limitations. In the past, the size of public hospital waiting lists was often used to gauge whether access to elective surgery was improving or declining. In the mid-1990s, the focus shifted to waiting times based around clinical urgency categories. However, variation in urgency categorisation meant that these measures were not comparable between states and territories and possibly between other groups. For example, the proportion of patients on elective surgery waiting lists at 30 June 2006 who were Category 1 in New South Wales was 4 times higher than in Victoria (9.4% of all patients on waiting lists, compared to 1.9% respectively).

This report presents new demand-related and supply-related measures of access to elective surgery. The supply-related measures are population rates of elective surgery provision, age- standardised to facilitate comparisons between population sub-groups. The demand-related measures use diagnosis and other information, rather than urgency categorisation, to assess access to elective surgery for different types of patients.

These new measures could be developed and further refined for routine reporting on access to elective surgery in the future.

New supply-related measures

In Australia in 2004–05, there were over 1.6 million hospital separations for elective surgery. Almost 1 million of these separations were for private elective surgery, with the remaining 629,000 separations being for public elective surgery.

Remoteness of residence

The rate of private elective surgery was highest for those living in Major Cities (51.9 per 1,000 persons) and decreased to 16.1 per 1,000 persons for Very Remote areas. In contrast, the rate of public elective surgery was lowest for those living in Major Cities (27.8 per 1,000) and highest for those living in Outer Regional areas (39.3 per 1,000).

Rates of admission for Plastic surgery varied markedly by remoteness, with people living in Major Cities admitted at four times the rate of people living in remote areas. People living in Very Remote areas were admitted for Cardiothoracic surgery at about one and a half times the rate for people living in other areas.

Socio-economic status

The rate of private elective surgery was highest for people in the Most advantaged socio- economic group (62.4 per 1,000 persons) and decreased with socio-economic advantage to

35.6 per 1,000 persons for the Most disadvantaged group.

Rates of admission for Gynaecology and Cardiothoracic surgery varied markedly by socio- economic group with people in the Most disadvantaged group admitted at twice the rate of people in the Most advantaged group.

Indigenous status

The overall rate of elective surgery (including private elective surgery) for Indigenous Australians (48.9 per 1,000 persons) was markedly lower than for Other Australians (85.5 per 1,000 persons). However, Indigenous patients were admitted from public hospital waiting lists for Cardiothoracic surgery, Vascular surgery and Ophthalmology at about twice the corresponding rates for other patients.

New demand-related measures

Overall for 2004–05 the median waiting time to admission from public hospital waiting lists was 29 days.

Remoteness of residence

People living in Very Remote areas had longer median waiting times (31 days) than people living in other areas. People living in Very Remote areas had the longest median waiting time for Ophthalmology (89 days, compared with 61 days overall) and the shortest median waiting time for Orthopaedic surgery (29 days, compared with 43 days overall). People in Outer Regional areas had the longest waiting times for Total hip replacement (111 days, compared with 97 days overall).

Socioeconomic status

Overall, people in the Most advantaged socio-economic group had the shortest overall median waiting time (24 days) and the Middle quintile group had the longest (31 days). The Middle quintile group had the longest median waiting times for Cardiothoracic surgery, Ophthalmology, Orthopaedic surgery, Neurosurgery and Ear, nose and throat surgery.

Indigenous status

Overall, Indigenous Australians and other Australians had the same median waiting time (28 days). Indigenous Australians had a shorter median waiting time than other Australians for Orthopaedic surgery (27 days and 42 days, respectively), but had a longer median waiting time for Total hip replacement (116 days and 91 days, respectively).

Diagnosis

Overall, the median waiting times for patients with cancer-related principal diagnoses were 15 days shorter than the median waiting times for patients with other conditions. Ophthalmology patients with a neoplasm waited 21 days compared with 63 days for patients with other conditions. Patients with a principal diagnosis of Acute myocardial infarction had a median waiting time of 2 days for Coronary artery bypass graft, compared with a median waiting time of 16 days for those with Chronic ischaemic heart disease.

Adverse events

Overall for 2004–05, an adverse event was reported as being treated or occurring during 5.4% of elective surgery separations. The rate of Adverse effects of drugs, medicaments and biological substances was about 40% lower for elective surgery than for all hospital separations. However for elective surgery, the rate of Misadventures to patients during surgical and medical care was more than twice the rate reported for all separations.