Hospitals – Admitted patient care and specialised facilities for palliative care

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In 2020–21, there were 90,700 hospitalisations where palliative care was provided during all or part of the episode of care in Australia. This section provides information related to these hospitalisations and the characteristics of people admitted for palliative care over the period 2015–16 to 2020–21. It also presents information on specialist palliative care inpatient units and expenditure for palliative care in public hospitals. Further information on palliative care-related hospitalisations can be found in the Data sources section and the Identifying palliative care-related hospitalisations section.

The information in this section was last updated in May 2023.

Key points

In 2020–21, among 90,700 palliative care-related hospitalisations:

  • 50,000 were for palliative care and 40,700 for other end-of-life care, equating to 19.5 and 15.9 per 10,000 population, respectively
  • males accounted for more than half – 53% both for palliative care hospitalisations and other end-of-life care hospitalisations
  • those aged 75 and over accounted for over 1 in 2 – 56% both for palliative care hospitalisations and other end-of-life care hospitalisations
  • 2 in 5 (42%) had a principal diagnosis of cancer – 1 in 2 (50%) for palliative care hospitalisations and almost 1 in 3 (31%) for other end-of-life care hospitalisations
  • average length of stay was almost twice as long as for all overnight hospitalisations (hospitalisations that exclude same-day stays) – 10 days (9.2 days for palliative care and 11.1 days for other end-of-life care) compared with 5.3 days for all hospitalisations
  • 1 in 2 hospitalisations (53%) ended with the patient dying in hospital (65% for palliative care hospitalisations and 40% for other end-of-life care hospitalisations).

Between 2015–16 and 2020–21, there was a 23% increase in the number of palliative care-related hospitalisations – this increase was at a steeper rate than for all hospitalisations (12% increase) over the same period.

In 2020–21, based on establishment-level data:

  • 112 or 1 in 6 (17%) public acute hospitals (excluding public psychiatric hospitals) in Australia had a specialised palliative care inpatient unit
  • the total palliative care expenditure in public hospitals care was $481.4 million (19% of all sub-acute care costs or 1.1% of total cost in these public hospitals), with an average cost per palliative care episode of $13,300 and average cost per palliative care phase of $7,800.

Who was hospitalised for palliative care?

In 2020–21, there were 11.8 million hospitalisations across Australia, including 90,700 hospitalisations where palliative care was provided during all or part of the episode of care (referred to as palliative care-related hospitalisations, see Identifying palliative care in hospital data for further details). More than half of these hospitalisations (55% or 50,000) had a care type of palliative care (referred to as palliative care hospitalisation), while 40,700 had a diagnosis of palliative care but the type of care delivered was not recorded as palliative care (referred to as other end-of-life care hospitalisation). This equates to 19.5 palliative care hospitalisations per 10,000 population and 15.9 other end-of-life care hospitalisations per 10,000 population (Table APC.1).

Most of the palliative care-related hospitalisations were recorded in public hospitals (85%), a higher proportion than that recorded for all hospitalisations (59%, Table APC.2).

In 2020–21, among 90,700 palliative care-related hospitalisations:

  • More were for males (53%) than females – a different pattern to that for hospitalisations for all reasons where females accounted for more than half (52%; see Table APC.1).
  • Over half (56%) were for people aged 75 and over – the average age at admission for palliative care-related hospitalisations was 74 years, which was considerably older than that for hospitalisations for all reasons (56 years). Almost 1 in 10 (9.0%) palliative care-related hospitalisations were for those aged under 55 (Table APC.1).
  • 2,400 were for Aboriginal and Torres Strait Islander people (1,400 for palliative care and 1,000 for other end-of-life care hospitalisations), with the majority occurring in public hospitals (95%) – a higher proportion than that observed for all hospitalisations (87% in public hospitals; see Table APC.5).
  • Those living in the lowest socioeconomic areas had hospitalisation rates in public hospitals twice as high as those in the highest socioeconomic areas – 43 compared with 20 per 10,000 population. Conversely, in private hospitals those in the highest socioeconomic areas had palliative care-related hospitalisation rates 2.6 times as high as those in the lowest socioeconomic areas (8.5 compared with 3.2 per 10,000 population, respectively). These same patterns were also observed for hospitalisations for all reasons, although for private hospitals the differences were not as marked (Figure APC.1 and Table APC.4).
  • Those living in Inner regional and Outer regional areas had the highest rate of palliative care hospitalisations in public hospitals – 22 and 24 per 10,000 population in Inner regional and Outer regional areas compared with 15 and 16 in Major cities and Remote and very remote areas (combined). For other end-of-life care hospitalisations, the rate of hospitalisations in public hospitals, increased with increasing remoteness (from 13 per 10,000 population in Major cities to 17 per 10,000 population in Remote and very remote areas combined), consistent with the pattern for all hospitalisations. However, a different pattern was observed for private hospitals where palliative care-related hospitalisations decreased with increasing remoteness, consistent with the pattern for all hospitalisations (Figure APC.1 and Table APC.3).

Figure APC.1: Characteristics of those hospitalised for palliative care or other end-of-life care, 2020–21

Figure 1.1: The interactive data visualisation shows the age distribution of palliative care hospitalisations and other end-of-life care hospitalisations. In 2020–21, the number of palliative care hospitalisations was the highest among those aged 75–84 years, while the number of other end-of-life care hospitalisations was the highest among those aged 85 or above. The rate (per 10,000 population) of hospitalisations generally increased with age for both palliative care and other end-of-life care, with the highest rate for those aged 85 years and over.

­­Figure 1.2: The interactive data visualisation shows differences by socioeconomic areas (using the SEIFA quintile distribution) of palliative care hospitalisations and other end-of-life care hospitalisations, by sector. In 2020–21, the number and rate (per 10,000 population) of palliative care and other end-of-life care hospitalisations in public hospitals increased by increasing disadvantage (highest in quintile 1 and lowest in quintile 5), while the reverse was observed in private hospitals (lowest in quintile 1 and highest in quintile 5).

Figure 1.3: The interactive data visualisation shows the remoteness distribution of palliative care hospitalisations and other end-of-life care hospitalisations, by sector in 2020–21. The highest number of palliative care hospitalisations were in Major cities, while the highest rate of palliative care hospitalisations per 10,000 population was in Outer regional areas for public hospitals. The highest number and rate (per 10,000 population) of palliative care hospitalisations for private hospitals were in Major cities. The highest number of other end-of-life care hospitalisation was in Major cities both for public hospitals and private hospitals. The highest rate (per 10,000 population) of other end-of-life care hospitalisation was in the Remote and very remote areas for public hospitals, and in Major cities for private hospitals.

Figure 1.4: The interactive data visualisation shows the distribution of palliative care hospitalisations and other end-of-life care hospitalisations, by sector in 2020–21 across different jurisdictions in Australia. New South Wales had the highest number and rate (per 10,000 population) of palliative care hospitalisations for public hospitals. While for private hospitals, Queensland had the highest number of palliative care hospitalisations (with publishable data), and Western Australia had the highest rate (per 10,000 population) of palliative care hospitalisations.  For other end-of-life care hospitalisations, Victoria had the highest number for public and private hospitals and Tasmania had the highest rate (per 10,000) for public hospitals, while Queensland and South Australia had the highest rate (per 10,000) for private hospital.

Figure 2: The interactive data visualisation shows the distribution of palliative care-related hospitalisations across Australia's 31 Primary Health Networks. The number of palliative care-related hospitalisations was the highest in the Central and Eastern Sydney. The highest rate (per 10,000 population) of palliative care-related hospitalisations was in North Coast. 

Figure 3.1: The interactive data visualisation shows the ten most common primary reasons for hospitalisations and for hospitalisations ending in death of palliative care hospitalisations and other end-of-life care hospitalisations in 2020–21. Cancers had the highest number and proportions for hospitalisations and hospitalisations ending in deaths for palliative care and other end-of-life care hospitalisations.

Figure 3.2: The interactive data visualisation shows the average length of hospital stay by reason for hospitalisations, hospital sector and type of separation for the 2020–21. For palliative care-related hospitalisations, the average length of overnight stay declined (from 10.4 days in 2015–16 to 9.6 days in 2020–21) in public hospitals, while in private hospitals, the average length of overnight stay remained relatively stable (around 12–13 days).

Figure 3.3: The interactive data visualisation shows the proportion of hospitalisations by status at discharge and by reason for hospitalisations for the 2020–21. The most common reason for discharge for palliative care-related hospitalisations in both public and private hospitals was death, followed by discharge to usual residence. Meanwhile, discharge to usual residence was the most common reason for discharge for hospitalisations for all reasons both in public hospitals and private hospitals.

Figure 4: The interactive data visualisation shows the proportion of principal source of funds by jurisdiction, reason for hospitalisations, and sector for the 2020–21. Public patients contributed the largest proportion of funding across public hospitals and all hospitals in all jurisdictions for palliative-related care hospitalisations. However, private health insurance was the principal source of funds for palliative care-related hospitalisations in private hospitals.

Figure 5: The interactive data visualisation shows trends in the number of hospitalisations by reason for hospitalisations and sector between 2015–16 and 2020–21. It shows that the number, rate (per 10,000 population), and age-standardised rate (per 10,000 population) of palliative-care related hospitalisations in public hospitals and all hospitals increased over the 5-year period, while it remained relatively stable for private hospitals over the same period.

Variation across geographical areas

The rate of palliative care-related hospitalisations varied across the states and territories, ranging from 29 hospitalisations per 10,000 population in Western Australia to 38 hospitalisations per 10,000 population in New South Wales (with publishable data).

  • In public hospitals, Tasmania recorded the highest rate (41 per 10,000 population) and Western Australia the lowest (19 per 10,000 population), while in private hospitals (with publishable data) Western Australia and Queensland recorded the highest (9.4 and 9.0 per 10,000 population) and New South Wales the lowest (3.0 per 10,000 population; Figure APC.1).

Across the Primary Health Networks (PHN) areas, the rate of palliative care-related hospitalisations varied as well, ranging from 24 hospitalisations per 10,000 population in Western Australia Perth North PHN area to 62 hospitalisations per 10,000 population in New South Wales North Coast PHN area (Figure APC.2).

  • For palliative care hospitalisations, those living in New South Wales North Coast PHN area also had the highest rate (45 per 10,000 population), while those living in Country South Australia PHN area had the lowest rate (11 per 10,000 population).
  • This pattern differed from other end-of-life care hospitalisations, where those living in Western Victoria PHN area had the highest rate (30 per 10,000 population), while those living in Queensland Gold Coast PHN area had the lowest rate (4.8 per 10,000 population).
  • In contrast, for hospitalisations for all reasons, those living in Northern Territory PHN area had the highest rate (7,700 per 10,000 population), while those living in Western Sydney PHN area had the lowest rate (3,400 per 10,000 population).

Figure APC.2: Palliative care-related hospitalisations, by Primary Health Networks (PHN) areas, 2020–21

Figure 2: The interactive data visualisation shows the distribution of palliative care-related hospitalisations across Australia's 31 Primary Health Networks. The number of palliative care-related hospitalisations was the highest in the Central and Eastern Sydney. The highest rate (per 10,000 population) of palliative care-related hospitalisations was in North Coast. 

What were the characteristics for their hospital stay?

Primary reason for hospitalisation

In 2020–21, among 90,700 palliative care-related hospitalisations, cancer was the most common principal diagnosis recorded for palliative care-related hospitalisations (42%) – 1 in 2 (50%) for palliative care hospitalisations and almost 1 in 3 (31%) for other end-of-life care hospitalisations (Table APC.7a).

  • Secondary site cancer (cancer of an unknown or ill-defined primary site) was the most frequently reported cancer (11% and 9.9% for palliative care and other end-of-life care hospitalisations, respectively), followed by lung cancer (8.2% and 3.8% for palliative care and other end-of-life care hospitalisations, respectively).
  • Most frequently reported principal diagnosis other than cancer was cerebrovascular disease (4.6%) and septicaemia (3.7%) for palliative care hospitalisations, and other ill-defined causes (5.4%) and septicaemia (5.1%) for other end-of-life care hospitalisations (Table APC.7a).

Average length of stay

In 2020–21, average length of stay for overnight palliative care-related hospitalisations (hospitalisations that exclude same-day stays) was almost twice as long as all overnight hospitalisations – 10 days (9.2 days for palliative care hospitalisations and 11.1 days for other end-of-life care hospitalisations) compared with 5.3 days for all hospitalisations (Figure APC.3). Among palliative care-related hospitalisations:

  • Patients spent on average longer in private hospitals than public hospitals – 12.4 days in private hospitals compared with 8.7 days in public hospitals for overnight palliative care hospitalisations and 12.8 days compared with 10.7 days, respectively, for overnight other end-of-life care hospitalisations. In contrast, the average length of stay for overnight hospitalisations for all reasons was relatively similar in private and public hospitals (5.1 and 5.4 days).
  • The average length of overnight hospital stays varied across states and territories in public hospitals – ranging from 7.0 days in Queensland to 11 days in the Australian Capital Territory for palliative care hospitalisations. A similar pattern was observed for other end-of-life care hospitalisations (8.6 days and 13 days respectively for these jurisdictions).
  • In public hospitals, the average length of stay declined for palliative care overnight hospitalisations (from 10.1 days to 8.7 days between 2015–16 to 2020–21), while average length of stay remained relatively stable for palliative care hospitalisations in private hospitals (around 12–13 days), other end-of-life care (around 11 days in all hospitals) and hospitalisations for all reasons (5.3–5.5 days in all hospitals) over the same period.

Status at discharge

In 2020–21, 1 in 2 palliative care-related hospitalisations (53%) ended with the patient dying in hospital – 65% for palliative care hospitalisations (66% in public hospitals and 53% in private hospitals). For other end-of-life care hospitalisations, 40% ended with a patient’s death (37% in public hospitals and 51% in private hospitals).

  • In public hospitals, the proportion of hospitalisations for palliative care that ended in death ranged from 63% in South Australia to 77% in Tasmania, and for other end-of-life care hospitalisations ranged from 15% in the Northern Territory to 47% in Victoria and South Australia (Table APC.9).
  • The next most common status at discharge was to usual residence (27%) – 23% for palliative care hospitalisations and 32% for other end-of-life care hospitalisations (Figure APC.3).

In 2020–21, 3 in 5 (63%) people who died in hospital had received palliative care or other-end-of-life care during their final hospitalisation (42% had a record for palliative care and 21% for other end-of-life care). This proportion was higher in patients with a principal diagnosis of cancer compared with those whose principal diagnosis was other than cancer (85% and 53% respectively; Table APC.7b).

Figure APC.3: Characteristics of palliative care-related hospital stay, 2020–21

Figure 3.1: The interactive data visualisation shows the ten most common primary reasons for hospitalisations and for hospitalisations ending in death of palliative care hospitalisations and other end-of-life care hospitalisations in 2020–21. Cancers had the highest number and proportions for hospitalisations and hospitalisations ending in deaths for palliative care and other end-of-life care hospitalisations.

Figure 3.2: The interactive data visualisation shows the average length of hospital stay by reason for hospitalisations, hospital sector and type of separation for the 2020–21. For palliative care-related hospitalisations, the average length of overnight stay declined (from 10.4 days in 2015–16 to 9.6 days in 2020–21) in public hospitals, while in private hospitals, the average length of overnight stay remained relatively stable (around 12–13 days).

Figure 3.3: The interactive data visualisation shows the proportion of hospitalisations by status at discharge and by reason for hospitalisations for the 2020–21. The most common reason for discharge for palliative care-related hospitalisations in both public and private hospitals was death, followed by discharge to usual residence. Meanwhile, discharge to usual residence was the most common reason for discharge for hospitalisations for all reasons both in public hospitals and private hospitals.

Who paid for the care?

Public and private hospitals both receive funding from the Australian Government, state and territory governments, private health insurance funds and out-of-pocket payments by individuals. However, the relative contributions made by these sources of funds vary across the sectors, reflecting the types of patients they treat, the services they provide, and the administrative arrangements in which they operate (AIHW 2021).

In 2020–21:

  • In public hospitals, public patient funding accounted for a lower proportion of palliative care-related hospitalisations than for all hospitalisations – 78% for palliative care, 81% for other end-of-life care and 86% for all hospitalisations. In contrast, private health insurance accounted for a higher proportion of funding for palliative care-related hospitalisations – 19% for palliative care and 16% for other end-of-life care, compared with 11% for all hospitalisations.
  • In private hospitals, private health insurance was the funding source for 59% of palliative care hospitalisations, lower than that for other end-of-life care (85%) and all hospitalisations (80%; Figure APC.4).

Figure APC.4: Proportion of principle funding source for palliative care-related hospitalisations, by sector, 2020–21

Figure 4: The interactive data visualisation shows the proportion of principal source of funds by jurisdiction, reason for hospitalisations, and sector for the 2020–21. Public patients contributed the largest proportion of funding across public hospitals and all hospitals in all jurisdictions for palliative-related care hospitalisations. However, private health insurance was the principal source of funds for palliative care-related hospitalisations in private hospitals.

How have hospitalisations changed over time?

Between 2015–16 and 2020–21, the number of palliative care-related hospitalisations increased more rapidly than hospitalisations for all reasons – 23% increase (from 73,600 to 90,700) compared with 12% increase (from 10.5 to 11.8 million), respectively. Among palliative care-related hospitalisations, the increase was steeper for other end-of-life care than palliative care hospitalisations over this period (29% compared with 19%, respectively). These increases in palliative care and all hospitalisations were observed in both public and private hospitals (Table APC.12).

While palliative care-related hospitalisations increased by 3–5% each year between 2015–16 and 2020–21, hospitalisations for all reasons had shown some fluctuations over the last 6 years – increased by 2–4% between 2015–16 and 2018–19, declined by 3% in 2019–20 and then increased by 6% the following year. These falls and rises in hospitalisations for all reasons in the 2 years to 2020–21 may reflect the introduction of public health measures (such as lockdowns and business/activity restrictions) in the early months of the COVID-19 pandemic to contain the spread of the virus, and the subsequent easing of restrictions in late 2020 through to mid-June 2021.

Between 2015–16 and 2020–21, the hospitalisation rate also increased – for palliative care-related hospitalisations from 31 to 35 per 10,000 population (17 to 20 per 10,000 for palliative care hospitalisations and 13 to 16 per 10,000 population for other end-of-life care hospitalisations) and from 4,400 to 4,600 per 10,000 population for hospitalisations for all reasons. When adjusting for changes in the age structure of the population over this period, the increases in hospitalisation rates had been considerable smaller – the age-standardised palliative care-related hospitalisation rate increased from 26 to 28 per 10,000 population and from 4,100 to 4,200 per 10,000 population for hospitalisations for all reasons (Figure APC.5). This suggests that the ageing of Australia’s population is contributing to the growth in palliative care-related hospitalisations.

Figure APC.5: Trends in palliative care-related hospitalisations, by sector, 2015–16 to 2020–21

Figure 5: The interactive data visualisation shows trends in the number of hospitalisations by reason for hospitalisations and sector between 2015–16 and 2020–21. It shows that the number, rate (per 10,000 population), and age-standardised rate (per 10,000 population) of palliative-care related hospitalisations in public hospitals and all hospitals increased over the 5-year period, while it remained relatively stable for private hospitals over the same period.

Visualisation not available for printing

In 2020–21, a total of 112 public acute hospitals reported having a specialist palliative care inpatient unit nationally (see Table NPHED.1 and Data sources for further details on this data collection). This represented 1 in 6 (17%) of the 674 public acute hospitals (excluding public psychiatric hospitals) in Australia included in the National Public Hospital Establishment Database (NPHED).

New South Wales and Western Australia had the highest number of public acute hospitals with specialist palliative care inpatient units (33 and 31, respectively), and Western Australia had the highest proportion of public acute hospitals with specialist palliative care units (37%).

Around 1 in 4 (27%) public acute hospitals in Major cities had a specialist palliative care inpatient unit, around twice the rate in other areas (14% in Inner regional and Outer regional areas combined and 12% in Remote and Very remote areas combined).

In 2020–21, among the 340 public hospitals that reported subacute care data to the Independent Health and Aged Care Pricing Authority (IHACPA), 259 hospitals had provided palliative care to patients, with a hospital cost of $481.34 million. This represents 19% of all subacute care cost ($2.56 billion) and 1.1% of total cost ($44.49 billion) in these 259 hospitals (Table NHCDC.1).  

In 2020–21, of the 36,100 palliative care episodes and 61,800 palliative care phases recorded, the average cost per palliative care episode was $13,300 and $7,800 per palliative care phase.

Almost half of this cost per episode related to ward nursing (34%) and ward medical (15%) cost buckets, 13% to ward supplies and 6% for allied health. Further, salaries and wages for nursing accounted for the biggest share (51%) of salaries for palliative care (line items), followed by salaries and wages for non-visiting medical officers (20%; Table NHCDC.1).