healthcare 2011-12: comparing performance across australia

8/13/2019 Healthcare 2011-12: Comparing performance across Australia

1/95

Healthcare 201112:Comparing performanceacross AustraliaReport to the Council of Australian Governments

30 April 2013


2/95


3/95

30 April 2013

The Hon Julia Gillard MP

Prime Minister

Parliament House

CANBERRA ACT 2600

Dear Prime Minister

On behalf of the COAG Reform Council I am pleased to present our report Healthcare 201112:

Comparing performance across Australia.

This is the COAG Reform Councils fourth report on the National Healthcare Agreement which aims to

improve health outcomes for all Australians and the sustainability of Australias health system.

Our report shows that the generally good health and quality healthcare enjoyed by Australians

continues to improve. Life expectancy is increasing and is among the highest in the world. Rates of

smoking, low birthweight babies and infant mortality are all improving and are lower than OECD

averages. We also report decreasing potentially preventable hospitalisations, deaths from avoidable

causes and emergency department waiting times.

Australias health system, however, still faces big challenges to meet the communitys justifiably high

expectations. We have an increasing chronic disease burden, a growing and ageing population, and

rising costs of services and health technologies.

This report shows that more progress is needed to reduce the impact of chronic diseases on the

health and wellbeing of Australians and on their health system. The obesity rate has grown, placing an

increasing burden on the health system from the management of conditions such as diabetes.

Circulatory disease remains one of our biggest killers.

Australians are also continuing to experience health inequalities based on who they are, how much

they earn and where they live, as detailed in our supplementary reports. We do not see consistently

strong performance across all States and Territories in key areas of hospital care and continue to find

that there are health inequalities for Indigenous Australians.

We hope that the findings in this report will continue to assist COAG with its reform agenda, and

contribute to ongoing engagement by all Australians in the improvement of their health and health

system.

Yours sincerely

JOHN BRUMBYChairman


4/95


5/95

HEALTHCARE 201112: COMPARING PERFORMANCE ACROSS AUSTRALIA / 5

Table of

contentsHealthcare 201112 key findings 6

Recommendations 9

Chapter 1. Health status of Australians 11

Key findings 13

Life expectancy between men and women 14

Death rates and causes 16

Infant death rates and birthweight 18

Heart attack incidence 20

Adults with high levels of psychological distress 22

Potentially preventable hospitalisations 24

Chapter 2. Healthy habits and behaviours 27

Key findings 29

Excess body weight 30

Adult daily smoking 32

Long term risk from alcohol consumption 34

Weight, smoking & alcohol by location & disadvantage 36

Chapter 3. Health system at work 39

Key findings 41

Waiting times for General Practitioners 42

Elective surgery waiting times 44

Emergency department waiting times 46

Differences in the community for hospital waiting times 48

Mental healthcare treatment and follow up 50

Rates of aged care services 52

Elapsed times for aged care services 54

Chapter 4. Performance benchmarks and National Partnerships 57

Key findings 59

Performance benchmarks 60

National Partnerships 62

Chapter 5. Improving performance reporting 65

More timely, meaningful data 66

Appendices 69

Appendix A The National Healthcare Agreement 71

Appendix B Terms used in this report 75

Appendix C Data sources and notes 79

Appendix D References 91

About the COAG Reform Council 94


6/95

the / HEALTHCARE 201112: COMPARING PERFORMANCE ACROSS AUSTRALIA

Healthcare 201112

key findingsAustralians are living longer and smoking less and there are signs ofimprovements in our health system. But governments need to tackleobesity and make sure all Australians have timely access to health care.

There are many indicators showing improving health and system performance

Our life expectancy is among the highest in the world, and our rates of low birthweight babies and infant

mortality are better than OECD averages1. While circulatory disease remains a leading killer, the rate of

heart attacks has fallen, as have potentially preventable hospitalisations and the rate of deaths from

potentially avoidable causes. Emergency departments continue their gradual improvement in waiting time

performance, however elective surgery waiting times remain a concern in some jurisdictions.

These and other results are detailed further in this report.

In our view though, there are three key findings particularly worth highlighting from our fourth report under

the National Healthcare Agreement. These are summarised below.

The adult smoking rate continues to fall

Australias progress in reducing smoking rates in the past two decades has been described as remarkableby the OECD (OECD, 2012a). In 198990, 28.4% of adults Australians were smokers (ABS, 1994). By

200708, this had fallen to 19.1%. We find that progress has continued.

In 201112, 16.5% of Australian adults smokedsignificantly lower than the rate in 200708. Significant falls

were also achieved in NSW (from 19.0% to 14.8%) and Queensland (21.6% to 17.5%). COAGs target is to

get the rate down to 10% of the population by 2018.

The lowest rate of smoking is in the ACT (13.4%),

while Tasmania (23.2%) and the Northern

Territory (22.6%) have the highest rates.

The smoking rate generally increases with the

degree of socio-economic disadvantage and with

remoteness.

For the first time, we have looked at the effects of

disadvantage and remoteness combined, showing

how they appear to compound the smoking rate.

For example, people living in the most socio-economically disadvantaged areas have the highest smoking

rates. But there are even pronounced differences between disadvantaged areas in major cities and those

outside major cities. About one in three people in the most disadvantaged areas outside major cities smoke,

compared to around one in five people in the most disadvantaged areas within our major cities.

By comparison, around one in ten people living in better off areas in major cities smoke.

0

5

10

15

20

25

Tas NT Qld SA WA Vic NSW ACT

%Adult smoking rate, 201112

Data source: ABS

1This is true for non-Indigenous Australians. However, Indigenous Australians have much poorer health outcomes, as detailed in the

councils report on the National Indigenous Reform Agreement available atwww.coagreformcouncil.gov.au/reports/Indigenous.cfm.

6
http://www.coagreformcouncil.gov.au/reports/Indigenous.cfmhttp://www.coagreformcouncil.gov.au/reports/Indigenous.cfmhttp://www.coagreformcouncil.gov.au/reports/Indigenous.cfmhttp://www.coagreformcouncil.gov.au/reports/Indigenous.cfm


7/95


The obesity rate has grown

In 201112, 63% of adults in Australia were either overweight or obese35% were overweight, while

another 28% were obese.

Data source: ABS.

Rates were higher for men than womenseven in every 10 men were overweight or obese, compared to

just over half of all women.

Not only has the overall rate of overweight and obese adults increased since 200708from 61.1% to

63.2%but the proportion of people who are obese now comprises a larger share.

Obesity increased in every State and the ACT, with the largest increases being in Queensland (up 5.5

percentage points to 30.5%), followed by South Australia (up 5.0 percentage points to 28.7%), then NSW

(up 4.3 percentage points to 27.7%). Data for the Northern Territory was not comparable over time.

Most people can see a GP for an urgent appointment w ithin 4 hours*

In 201112, 63.6% of people reported that they could see a GP for an urgent appointment within 4 hours,

12.0% reported that they could see a GP in more than 4 though less than 24 hours, while 24.4% had to wait

more than 24 hours.

There was an increase in the proportion of people who felt that they waited an unacceptable time to see a

GP for an urgent appointment from 17.8% in 2009 to 27.4% in 201112. This is a large increase in a short

period of time and it would be prudent to treat this result with some caution until future data are available.

*This is a revised findingsee page 43.

Normal weight Overweight Obese

7 in 20 adults are normal w eight 7 in 20 adu lts are overw eigh t 6 in 20 adu lts are ob ese

7


8/95

the / HEALTHCARE 201112: COMPARING PERFORMANCE ACROSS AUSTRALIA


9/95


Recommendations

Recommendation 1

The COAG Reform Council recommends that COAG note:

a. that there has been good prog ress against a range of indicators, including potentially

preventable hospitalisations, potentially avoidable deaths and emergency department waiting

times

b. the continuing good progress toward the target to reduce the smoking rate to 10% by 2018,

though effort must be maintained

c. the lack of progress toward the target to increase by five percentage points the proportion ofAust ral ian adults and chi ld ren at a healthy body weight by 2018

d. the proportion of people reporting that they had to wait longer than 24 hours for an urgent

appointment with a general practitioner was 24.4%.

Recommendation 2

The COAG Reform Council recommends COAG agreethat, while good progress has been made in recent

years, further work is needed to ensure that timely and relevant data are available to the council, including:

a. more recent data for the incidence of selected cancers

b. more data that are disaggregated by degree of remotenessparticularly in key indicators

such as life expectancy, potentially avoidable deaths, and rates of heart attack

c. a more approp riate measure than number of attendances for reporting potentially avoidable

GP-type presentations to emergency departments.

Recommendation 3

The COAG Reform Council recommends COAG, consistent with the findings of the 2012 review of the

National Healthcare Agreement performance indicator framework, agreeto further work being done to:

a. develop a benchmark for timely access to aged care services

b. develop more comprehensive performance indicators for reporting progress against the

sustainabilit y outcome of ensuring that the health system can respond and adapt to future

needs

c. set a new target, in consul tation with the Australian Commiss ion on Safety and Quality in

Health Care, for the benchmark on healthcare associated infections (for which the 201112

target was achieved by all States and Territories).

9


10/95

Chapter 1: Health status of Australians

10 / HEALTHCARE 201112: COMPARING PERFORMANCE ACROSS AUSTRALIA


11/95



Chapter 1.

Health statusof AustraliansThis chapter reports the leading indicators on the health status of Australians, including forhow long we live, leading causes of death, and leading contributors to ill health.


12/95



How this chapter links to the National Healthcare Agreement

Section in thi s chapter Performance indicators Outcomes

Life expectancy

between men and women Life expectancy

Australians are born and remainhealthy

Death rates

and causes

Major causes of death Australians are born and remain

healthy

Potentially avoidable deaths

Australians receive high qualityand affordable primary andcommunity health services

Infant death rates

and birthweight

Proportion of babies born of lowbirth weight


Infant and young child mortalityrate

Heart attack

incidence Incidence of heart attacks


Adul ts wi th high levels of

psychological distress

Proportion of adults with veryhigh levels of psychologicaldistress


Potentially preventable

hospitalisations

Selected potentially preventablehospitalisations

Australians receive high qualityand affordable primary andcommunity health services

A number of these performance indicators also link to the National Healthcare Agreement outcome

Australians have a health system that promotes social inclusion and reduces disadvantage,

especially for Indigenous Australians.

Like to know more about the indicators?

Appendi x A outlines the structure of the National Healthcare Agreement and details the indicators

that are not included in this report in detail, either due to data quality and availability issues, orbecause there was little change in performance year on year.


13/95



Key findingsHeart attack rates have fallen.While circulatory diseases remain a leading cause of death in

Australia, between 2007 and 2010 rates of heart attacks decreased across all age groups and among

both men and women. The rate of heart attacks in the Indigenous population has fallen, though the

drop is much smaller than occurred for the non-Indigenous population.

Hospitalisations for potentially preventable chronic condit ions have fallen. The rate at

which people are hospitalised for potentially preventable conditions fell 7.3% from 200708 to

201011. This was driven by a drop in hospitalisations for potentially preventable chronic conditions.

While the rate has improved, more than one in ten Australian adults (10.8%)

experienced high or very high psychological distress.Around 3% of Australian adults

reported having very highpsychological distresspeople were more likely to report very high levels of

psychological distress if they:

lived in the most disadvantaged parts of the nation, compared to people living in the least

disadvantaged parts

had disability, compared to people without disability.

There has also been a drop in the rate of potentially avoidable deaths.Between 2009

and 2010, there was a significant fall in the rate of potentially preventable deaths and the rate of

deaths from potentially treatable conditions.

Summary of key findings in this chapter

Rate of heart attacks in

2010 was 443.1 per 100 000

people

Proportion of adults with

high or very high

psychological distress was

10.8% in 201112

Rate of potentially preventable

hospitalisations for chronic

condit ions was 1112.4 per

100 000 people in 201011

Down 16.2%

Down 1.2percentage points

Down 14.9%


14/95



Life expectancybetween men and womenLife expectancy for both men and women has increased,but the gap between the sexes remains.

Despite an increase in life expectancy for both men and women, men continue to have

a life expectancy four and a half years lower than women

Life expectancy is used as a key measure of population health. Australia has one of the highest life

expectancies in the world (see Figure 1.1).

Figure 1.1 Life expectancy for men and women, Australia and other OECD count ries, 2010

Source: OECDsee Appendix C.

Women born in 200911 have a substantially longer life expectancy (84.2 years nationally) than men

born in 200911 (79.7 years nationally), in all jurisdictions (see Figure 1.2).

The ACT has the highest life expectancy for both men (81.0 years) and women (84.8 years). Life

expectancy is lowest in the Northern Territory for men (74.9 years) and women (80.5 years).

Figure 1.2 Life expectancy by sex, by State and Territo ry, 200911

Source: ABSsee Appendix C.

70

72

74

76

78

80

82

84

86

88

90Women

MenYears

50

60

70

80

90

100

NSW Vic Qld WA SA Tas ACT NT Aust

Yea

rs

Men Women


15/95



Men gained more years of l ife than women between 200608 and 200911

In all jurisdictions other than Tasmania and the Northern Territory, men born in 200911 had a life

expectancy of at least 79 years and women had a life expectancy of at least 84 years. People in

Tasmania and the Northern Territory had lower life expectancy:

78.3 years for men and 82.5 years for women in Tasmania

74.9 years for men and 80.5 years for women in the Northern Territory.

In all States and Territories between 200608 and 200911, men gained more years of life than

women (see Figure 1.3). There were substantial increases in the Northern Territory for both men (an

additional 2.3 years) and women (an additional 2.1 years).

Figure 1.3 Change in life expectancy at bir th by sex, 200608 to 200911


Life expectancy changes as people age

In discussing life expectancy, it is important to keep in mind that it is an estimate of the average

expected life span of all babies born at a certain time. Because it is an average, not all those babies

can expect to reach that agesome may die as infants, children, or young adults.

As a person ages, and outlives others who die earlier, their overall life expectancy increases. So,

while a woman born in 2010 had a life expectancy of 84.0 years, by the time she reaches 20 she

would have already outlived some of her contemporaries, and would be expected to live, on average,

a further 64.5 years. If she lives to be 100far beyond the average life expectancy when she was

bornshe can expect to live, on average, another 2.7 years (see Figure 1.4).

Figure 1.4 Years of life remaining at dif ferent ages, 20082010

At exact age (years) Men (years o f l ife remaining) Women (years of li fe remaining)

0 79.5 84.0

20 60.2 64.5

50 31.7 35.4

100 2.5 2.7


0

1

2


Years Menadditional years' life gained between 200608 and 200911

Womenadditional years' life gained between 200608 and 200911


16/95



Death ratesand causesRates for the leading causes of deathcancer, circulatorysystem diseases, respiratory system diseases andexternal causesall fell between 2007 and 2010, as diddeaths from potentially avoidable causes.

Between 2007 and 2011, overall death rates fell

Australias 2011 death rate was 560.0 deaths per 100 000 peopledown from 596.7 in 2007.

In 2011, each State and Territory had a significantly lower death rate than in 2007 (see Figure 1.5).NSW (569.5 deaths per 100 000), Tasmania (646.4 deaths per 100 000) and the Northern Territory

(732.8 deaths per 100 000) had significantly higher death rates than the national rate.

Figure 1.5 Death rates by State and Territory , 2007 to 2011


Cancer and heart disease were responsible for most deaths in 2010

Leading causes of death in 2010 were neoplasms (cancers) and circulatory system diseases (such as

heart disease).

In 2010, deaths by cancer:

were significantly higher in Tasmania (196.3) compared to the national average (175.9)

were significantly lower in the ACT (157.7) compared to the national average (175.9).

0

100

200

300

400

500

600

700

800

900

1000


Ra

teper

100000peop

le

2007 2008 2009 2010 2011


17/95



In 2010, deaths by circulatory disease:

were significantly lower nationally (173.5) than in the previous year (183.7)the rate has dropped

significantly each year since 2008

were significantly higher than the national rate (173.5) in Queensland (180.4), South Australia

(182.8) and Tasmania (215.4)

were significantly lower than the national rate (173.5) in Victoria (164.3) and Western Australia

(158.8)

had decreased significantly in NSW, Victoria, Queensland, Western Australia, South Australia and

Tasmania since 2007.

The rate of potentially avoidable deaths has fallen significantly

In 2010, nearly 33 000 Australians under 75 years old died from potentially avoidable deaths.

Between 2007 and 2010, the rate of potentially avoidable deaths fell nationallyfrom 158.7 to

148.0 deaths per 100 000 people. Despite a significant drop in the Northern Territorys potentiallyavoidable death rate (from 361.3 to 278.3 per 100 000 people), it remained significantly higher than all

other jurisdictions.

Potentially avoidable deaths can be divided into potentially preventable deaths and deaths from

potentially treatable conditions. Potentially preventable deaths are those amenable to screening and

primary prevention, such as immunisation. Deaths from potentially treatable conditions are those

amenable to therapeutic interventions.

In 2010, there were over 20 000 potentially preventable deaths and over 12 000 deaths from

potentially treatable conditions. Both the potentially preventable and treatable death rates have fallen

significantly since the baseline, and in the most recent year for which data are available (between

2009 and 2010) (see Figure 1.6).

Nationally between 2009 and 2010:

the rate of potentially preventable deaths fell significantly from 94.8 to 91.3 per 100 000 people

the rate of deaths from potentially treatable conditions fell significantly from 59.7 to 56.7 per

100 000 people.

Figure 1.6 Rates of potentially preventable deaths and deaths from potentially treatable

condi tions by State and Territory, 2007 to 2010


0

50

100

150

200

250


Per

10000

0peop

le

Preventable Treatable


18/95



Infant death ratesand birthweightInfant death rates have fallen and rates of low birthweightbabies are stableAustralias rates are better than theOECD average, but not for Indigenous Australians.

Nationally, infant death rates fell from 4.2 infant deaths per 1000 live births in 2011 to

3.8 deaths per 1000 live births in 2007

Due to the small number of infant (less than one year old) deaths each year, data by State and

Territory are combined over three years and data by Indigenous status are combined over five years.

In 200911, Queensland (5.1 infant deaths per 1000 live births) and the Northern Territory (7.3 infant

deaths per 1000 live births) had the highest infant mortality rates (see Figure 1.7).

In 200711, the rate of Indigenous infant mortality was 7.4 deaths per 1000 births compared to

3.9 deaths among non-Indigenous babies. Indigenous data are for selected states onlyNSW,

Queensland, Western Australia, South Australia and the Northern Territory. Indigenous infant deaths

are also discussed in our report under the National Indigenous Reform Agreement.

Figure 1.7 Infant death rates 200608 to 200911, Indigenous infant death rates 200711


Austral ias infant death rate compares well internat ionally

Figure 1.8 shows that Australia has had a lower infant death rate than most other OECD countries for

over 50 years. While this is good, the challenge remains to continue to lower the Indigenous rate.

Figure 1.8 Infant death rates, Australia and other OECD count ries since 1960

Source: UN Inter-agency Group for Child Mortality Estimationsee Appendix C.

0

5

10

15


Per1

000live

births

200608 total population 200709 total population

200810 total population 200911 total population

200711 Indigenous population

0 . 0

1 0 . 0

2 0 . 0

3 0 . 0

4 0 . 0

5 0 . 0

6 0 . 0

7 0 . 0

8 0 . 0

9 0 . 0

1 0 0 . 0

0

20

40

60

80

100

1960 1970 1980 1990 2000 2010

Australia

OECD average

Per

1000live

births

Other nations


19/95



Rates of low bi rthweight babies remained stable

Nationally, 4.8% of live, singleton babies born in 2010 were of low birthweight. A much higher

proportion of live, singleton babies born to Indigenous mothers were of low birthweight (10.7%),

though there was a fall over the period 2000 to 2010 (see Figure 1.9). Low birthweight babies born to

Indigenous mothers are also discussed in our report under the National Indigenous Reform

Agreement.

Figure 1.9 National propo rtion of low birthweight babies, and the national proportion of low

birthweight babies born to Indigenous mothers, since 2000

Notes:

1. 20002004 Indigenous data are based on selected states onlyNSW, Victoria, Queensland, Western Australia, SouthAustralia and the Northern Territory.

Source: AIHWsee Appendix C.

Austral ias rate of low bi rthweight babies compares wel l internationally

Because the national rate has been stable for so long, we have looked at how Australias ratecompares internationally (see Figure 1.10).

For international comparisons, Australias rate is 6.2%. This is higher than the rate we report above

because it includes multiple births (such as twins and triplets).

This comparison rate is lower than the OECD average (6.7%), as well as the UK (7.4%) and US

(8.2%). It is higher than the lowest rate of 4.1%, achieved in both Iceland and Sweden. The rate for

babies born to Indigenous mothers in Australia is much higher than the OECD average.

Figure 1.10 Low birthweight babies in Australia in 2010, the OECD average and other

count ries in 2009

Source: OECD, World Bank, AIHWsee Appendix C.

0

3

6

9

12

15

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Percen

tAust Indigenous

National Healthcare Agreementbaseline year

0

3

6

9

12

15

Iceland Sweden Canada Australia OECD Germany UK US Japan Indonesia IndigenousAust ralians

Perce

nt


20/95



Heart attack

incidenceFrom 2007 to 2010 nationally, the rate of heart attacks fell16.2%Indigenous Australians, men and older peoplewere more likely to have a heart attack.

The rate of heart attacks fell f rom 2007 to 2010

We report the rate of heart attack incidentsit is possible that an individual may be counted more

than once, in the case of one person having multiple heart attacks.

Over the four years to 2010, the national rate of heart attacks dropped from 528.6 heart attacks per100 000 people in 2007 to 443.1 in 2010. In other words, Australia had 85.5 fewer heart attacks per

100 000 people in 2010 than in 2007.

Men and older people have higher rates of heart attacks

The rate of heart attacks increases by age group.

Between 2007 and 2010, the rate of heart attacks dropped across all age groups (see Figure 1.11).

The rate for each age group aged over 55 years dropped by more than 15%.

Figure 1.11 Change in rate of heart attacks per 100 000 people between 2007 and 2010

2534years

3544years

4554years

5564years

6574years

7584years

85+years

Fall in heart attacksper 100 000 people

3.1 9.2 31.3 112.7 233.6 356.2 587.0

These areproportionalfalls o f...

21.8% 9.7% 9.9% 17.1% 19.5% 16.8% 15.5%


Men are more likely to have a heart attack than women.

In 2010, the heart attack rate for men (603.7) was more than double the rate for women (296.4 per

100 000 people)this was the case across all age groups under 75 years.

Between 2007 and 2010, the rate of heart attacks for both men and women dropped by around 16%

(see Figure 1.12).


21/95



Figure 1.12 Rate of heart attacks by age and sex, 2007 to 2010


Indigenous Australians are more than twice as likely to have a heart attack as

non-Indigenous Australians

The rate of heart attacks in the Indigenous population occurs at more than double the non-Indigenous

rate (see Figure 1.13). Indigenous data are from only some jurisdictionsNSW, Queensland,

Western Australia, South Australia and the Northern Territory.

In 2010 the rate of heart attacks for:

the Indigenous population was 1123.3 per 100 000 people

the non-Indigenous population was 428.5 per 100 000 people.

Between 2007 and 2010, the Indigenous rate fell significantlyby 7.3%from 1211.3 to 1123.3 heart

attacks per 100 000 people. This was a smaller fall than the non-Indigenous rate (17.2%).

Figure 1.13 Rate of heart attacks by Indigenous status, 2007 to 2010

Notes:

1. Data in this graph are based on selected states onlyNSW, Queensland, Western Australia, South Australia and theNorthern Territory.


0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2534 3544 4554 5564 6574 7584 85+

Men

Women

Rate per 100 000p eople

Age (years)

0

200

400

600

800

1000

1200

1400

2007 2008 2009 2010

Rateper 100 000 population

Non-Indigenous

Indigenous


22/95



Adults with high levels ofpsychological distressOne in ten adults experiences high or very high levels ofpsychological distressit is more prevalent amongwomen, Indigenous Australians, people with disability andpeople in disadvantaged areas.

Around 3% of adults reported very highlevels of psychological distresswomen

were more likely to report very high levels of psychological distress than men

Psychological distress contributes greatly to the total burden of disease in Australia. There is a strong

link between psychological distress and anxiety and affective disorders (AIHW 2012).In 201112:

3.4% of Australian adults reported very high psychological distress levels

10.8% reported high/very high psychological distress levels (see Figure 1.14).

In 201112, the proportion of adults who reported high/very high levels of psychological distress was

significantly lower than in 200708 (12.0%).

A higher proportion of women reported very high distress levels compared to men. In 201112:

4.1% of women experienced very high levels of psychological distress

2.7% of men experienced this level of distress.

Figure 1.14 Proportion of adults with high/very high psycholog ical distress, 201112


0

5

10

15


Percen

tHigh and very high levels Very high levels


23/95



People with disability and Indigenous Australians are more likely to experience

psychological distress than the rest of the population

In 201112, compared to the rest of the population, people with disability were just under eight times

as likely to report very highdistress levels:

8.2% of people with disability reported very high levels of psychological distress

1.1% of people without disability reported these distress levels (see Figure 1.15).

In 2008, around a third of Indigenous adults reported high/very highlevels of psychological distress:

31.2% of Indigenous adults reported high/very high psychological distress

12.3% of non-Indigenous Australians reported these distress levels.

Psychological distress is more prevalent in areas of soc io-economic disadvantage

In 201112, people living in the most socio-economically disadvantaged areas were more than twice

as likely to experience very highdistress levels as those in the least disadvantaged areas (5.4%compared with 1.9%). Levels of distress steadily decreased as levels of disadvantage decreased.

Rates of psychological distress do not vary significantly by area of remotenessthere was no

significant difference in the proportion of adults with high/very high psychological distress in major

cities, inner regional areas or outer regional areas.

The proportion of adults living in major cities who reported high/very high levels of psychological

distress dropped significantly between 200708 (12.1%) and 201112 (10.6%).

Figure 1.15 High/very high psycholog ical distress by disabili ty status, area of socio -

economic disadvantage and geographic location, 201112, and Indigenous

status, 2008


11.2

10.6

12.3

31.2

1.9

5.4

1.1

8.2

0 5 10 15 20 25 30 35

Outside major cities

Major cities

non-Indigenous

Indigenous

Least disadvantaged

Most disadvantaged

People without disability

People with disability

Highan

dve

ryhighleve

ls

Very

highleve

ls

Per cent


24/95



Potentially preventablehospitalisationsThe rate of potentially preventable hospitalisations hasdropped between 200708 and 201011.

The decrease was driven by a fall in hospitalisations for chronic conditions

The overall rate of potentially preventable hospitalisations comprises vaccine-preventable conditions,

potentially preventable acute conditions, and potentially preventable chronic conditions.

In the four years to 201011, the total rate of potentially preventable hospitalisation fell by 7.3%.

This year, we focus on chronic conditions, which include diabetes, asthma, angina, hypertension,

congestive heart failure and chronic obstructive pulmonary disease. The data we report excludediabetes complications (additional diagnoses only).

In 201011, chronic conditions were responsible for over 265 000 potentially preventable

hospitalisations38 000 fewer than the previous year.

The rate of potentially preventable hospitalisations due to chronic conditions fell from 1361.0

hospitalisations per 100 000 people in 200708 to 1112.4 in 201011. In the most recent year alone,

potentially preventable hospitalisations due to chronic conditions fell by 14.9% (see Figure 1.16).

Figure 1.16 Potentially preventable hospi talisations due to chron ic condi tions , by State and

Territory , 200708 to 201011

Notes:

1. Tasmanias 200809 data are not comparable with the other years data for Tasmania.


0

500

1000

1500

2000

2500


200708 200809 200910 201011Per100 000 peop le


25/95



Improvement occurred in all areas of remoteness, and all areas of disadvantage

The drop in potentially preventable hospitalisations due to chronic conditions occurred across all

areas of socio-economic disadvantage, and all areas of remoteness (see Figure 1.17).

Figure 1.17 Potentially preventable hospi talisations due to chron ic condi tions by socio-

economic area and locat ion , 200708 to 201011


0

500

1000

1500

2000

2500

3000

Major c ities Inner reg ional Outer reg ional Remote Very remote

Per 100 000 people

0

500

1000

1500

2000

Per 100 000 people

Most disadvantaged Least disadvantaged


26/95




27/95

Chapter 2: Healthy habits and behaviours


Chapter 2.

Healthy habitsand behavioursThis chapter reports prominent lifestyle risk factorsobesity, smoking and alcohol

consumptionthat contribute to a range of adverse health outcomes.


28/95




Section in this chapter Performance indicators Outcomes

Excess

body weight

Proportion of adults and childrenwho are overweight or obese

Australians are born andremain healthy

Adul t dail y

smoking

Proportion of adults who arecurrent daily smokers


Long term risk from

alcohol consumption

Proportion of adults at risk oflong-term harm from alcohol


Weight, smoking & alcohol

by location and disadvantage

Proportion of adults and childrenwho are overweight or obese

Proportion of adults who arecurrent daily smokers

Proportion of adults at risk of

long-term harm from alcohol







that are not included in this report in detail, either due to data quality and availability issues, or

because there was little change in performance year on year.


29/95

Chapter 2: Healthy habits and behavioursHEALTHCARE 201112: COMPARING PERFORMANCE ACROSS AUSTRALIA / 29

Key findingsObesity has increased.In 201112, more than one in four adults were obesea significant

increase since 200708. Men were more likely to be overweight or obese than women, and the rate

for men has increased. Between 200708 and 201112, rates of overweight and obesity significantly

increased in:

Queensland, from 61.2% to 65.4%

South Australia, from 60.9% to 66.1%.

Child rates of excess weight significantly increased in Tasmania over this timefrom 18.7% to 28.6%.

Smoking rates have fallen.Australia has continued to make progress in reducing daily smokingrates. There has been a drop in the proportion of male and female daily smokersnevertheless men

continue to be more likely to smoke than women. Encouragingly, there have also been some

significant falls in the proportion of daily smokers among some of the younger age groups. Between

200708 and 201112, smoking rates significantly decreased in:

NSW, from 19.0% to 14.8%

Queensland, from 21.6% to 17.5%.

Alcohol consumption at r isky levels has dropped. There has been a small but statistically

significant fall in the proportion of adults who drink at levels that put them at risk of long-term harm.

Around one in five consume alcohol at quantities that exceed the lifetime risk guidelines. Men are

more likely to drink at risky levels than women across all States and Territories. Compared with the

national rate, a higher proportion of adults in Western Australia (25.3%), Tasmania (22.8%) and the

Northern Territory (24.2%) drank at risky levels. Victorians were less likely to do so (17.5%).

Summary of key findings in this chapter...

Proportion of adults who were

obese in 201112 was 28.1%

Rates of current daily

smokers was 16.5% in

201112

Proportion of adults who

consumed alcohol at risky

levels was 19.4%

Down 1.5

percentage pointsUp by 3.7

percentage points

Down by 2.6percentage

points


30/95



Excessbody weightIn 201112, nearly 2 in 3 adults were overweight orobese1 in 4 were obese, a 15% increase since 200708.Rates of overweight and obesity were higher for men.Rates for children were stable.

Rates of overweight and obesity increased nationally, in Queensland and South

Austral ia

In 201112, 63.2% of Australian adults (aged 18 years and over) were overweight or obese (see

Appendix B for how overweight and obesity are calculated). Queensland (65.4%), Western Australia(66.0%) and South Australia (66.1%) had a significantly higher proportion of overweight and obese

adults than the national rate. NSW had a significantly lower proportion (61.1%) (see Figure 2.1).

Between 200708 and 201112, the rate of adult overweight and obesity significantly increased:

nationally, from 61.1% to 63.2%

in Queensland, from 61.2% to 65.4%

in South Australia, from 60.9% to 66.1%.

Nationally, the increase in adult overweight and obesity has been driven by an increase in the obesity

rate. Since 200708, the proportion of obese adults has risen by 3.7 percentage pointsequivalent to

a 15% increase. The rate of obesity among adults increased from 24.4% to 28.1%higher than themost recent OECD average (22.2% in 2010) (OECD, 2012b). Significant increases also occurred in

NSW, Queensland and South Australia.

The increase in obesity far outweighs the 1.6 percentage point fall (36.7% to 35.1%) in the proportion

of overweight adults.

Figure 2.1 Overweight and obesi ty in 201112 and change since 200708

Proportion of adults who are overweight or obese

Percentage point change 200708 to 201112 Overweigh t and obesi ty rates in 201112

Notes:1. Data for the Northern Territory are not comparable over time.


35.1

35.7

38.4

36.1

37.4

36.6

35.0

36.0

33.3

28.1

28.0

25.2

28.0

28.7

29.4

30.5

25.9

27.7

0 10 20 30 40 50 60 70

Aust

NT

ACT

Tas

SA

WA

Qld

Vic

NSW

3.7*

4.2

1.5

5*

3.8

5.5*1.4

4.3*

-1.6*

0.4

-0.1

0.3

-0.8

-1.1-0.5

-3.8*

-6 -4 -2 0 2 4 6

Overweight

Obese

* Statisticallysignificant c hange


31/95



Rates of overweight and obesity for children have remained stable overallbut have

increased signif icantly in Tasmania

In 201112, 25.3% of children (aged 517 years) were overweight or obese17.7% overweight and7.6% obese (see Figure 2.2). These were similar to rates in 200708.

Australias rates are higher than international comparisonsin 2011, the latest available OECD

average of overweight and obesity for children was 21.4% for girls, and 22.9% for boys (OECD,

2011).

Tasmania was the only state where rates of child overweight and obesity increased significantly, from

18.7% in 200708 to 28.6% in 201112.

Figure 2.2 Proportion of adults and children in each weight category, 201112


Overweight and obesity are still more prevalent among menand increasing

Men (70.3%) are more likely to be overweight or obese than women (55.7%)in particular, men in

the 2569 year age cohorts have significantly higher rates than women in these age groups.

Overall, between 200708 and 201112, the proportion of overweight or obese men increased

(67.8% to 70.3%). The proportion of overweight or obese women did not change significantly (54.3%

to 55.7%), except for women aged 4554 years old, for whom it increased from 58.7% to 64.6%.

Figure 2.3 Overweight and obesi ty by sex, by age, 201112


Australias progress towards the benchmark to increase the proportion of adults and children at a

healthy body weight is reported on p.60.

0 10 20 30 40 50 60 70 80 90 100

Per cent

Underweight Normal weight Overweight Obese

Adul ts

Children

42.4

55.3

64.6

65.5

74.180.6 82.6

0

20

40

60

80

100

1824 2534 3544 4554 5564 6569 7074 75+

P

ercen

t Women

Men


32/95



Adult dailysmokingThe national adult daily smoking rate was 16.5% in201112, down from 19.1% in 200708positively, a falloccurred in younger age groups and for both sexes.

The rate of daily smokers dropped significantly nationally, in NSW and in Queensland

Tobacco smoking is the largest single preventable cause of death and disease in Australia,

responsible for the greatest burden on our health (NHMRCNICS, 2003). The OECD has noted

Australias remarkable progress in reducing tobacco consumption in the last two decades. In

198990, 28.4% of Australian adults smoked (ABS, 1994). Australias smoking rate is now one of the

lowest rates of all OECD countries (OECD, 2012a).

In 201112, 16.5% of Australian adults were daily smokers. Between 200708 and 201112, the

proportion of daily smokers fell significantly nationally (19.1% to 16.5%), in NSW (19.0% to 14.8%)

and in Queensland (21.6% to 17.5%) (see Figure 2.4).

In 201112, compared to the national rate, the proportion of daily smokers was:

significantly lower in NSW (14.8%) and the ACT (13.4%)

significantly higher in Tasmania (23.2%) and the Northern Territory (22.6%)the data do not

include very remote areas, which may affect the Northern Territory estimates.

Figure 2.4 Smoking rates by State and Territo ry, 200708 to 201112

Notes:

1. Data for the Northern Territory are not comparable over time.


There was a fall in the proport ion of daily smokers among younger age groups

Encouragingly, there have been significant falls among some of the younger age groups. The

proportion of 2534 (24.4% to 20.4%) and 3544 (23.2% to 19.0%) year olds who were daily smokers

dropped significantly between 200708 and 201112 (see Figure 2.5).

0

10

20

30

40

50


Percen

t200708 201112


33/95



Looking at the falls in these rates by sex, we found that significant decreases occurred for:

men aged 2534, from 29.5% to 22.7%

women aged 3544, from 20.3% to 15.7%.

Despite these decreases, younger people are still more likely to be daily smokers. In 201112, over

55 year olds were less likely to be daily smokers than 25 to 44 year olds.

Figure 2.5 National smoking rates by age, 200708 to 201112


Smoking rates dropped across sexesbut men are still more likely to be smokers

The significant drop in rates of daily smokers occurred for both men (21.0% to 18.3%) and women

(17.2% to 14.6%). The drop in the rate for men did not close the gap between the sexes. In 201112

nationally, men were still significantly more likely to be daily smokers than women (see Figure 2.6)

this particularly applied to 2534 and 3544 year olds. Men also had significantly higher smoking

rates than women in Victoria, Tasmania and the Northern Territory.

Figure 2.6 Smoking rates by sex, 201112


People with disability are more likely to be daily smokers

In 201112, people with disability (21.8%) had a significantly higher proportion of daily smokers than

people without disability (14.4%), in most States. Estimates in less populous jurisdictions are

consistent with this finding, though come with greater statistical uncertainty.

Australias progress towards the smoking benchmark of 10% by 2018 is reported on p.61.

0

10

20

30

40

50

1824 2534 3544 4554 5564 6569 7074 75+

Per cent

200708

201112

0

10

20

30

40

50


Per cent Male Female


34/95



Long term risk fromalcohol consumptionIn 201112, around 1 in 5 adul ts drank alcohol at levelsthat put them at risk of long-term harm. Adults in Western

Australia, Tasmania and the Northern Territory were morelikely to drink at risky levels, and men were more likely todo so than women.

Nationally, adults drinking at levels that increased their lifetime risk of harm from

alcohol-related disease or injury fell between 200708 and 201112

Alcohol is responsible for a substantial burden of death, disease and injury in Australia. TheAustralian Guidelines to Reduce Health Risks from Drinking Alcohol state that the lifetime risk of harm

from drinking alcohol increases progressively with the amount consumed (NHMRC 2009).

We report the proportion of adults who have consumed an average of more than two standard drinks

per dayan amount that puts them at long term risk of harm.

Nationally, around one in five Australian adults (19.4%) drank more than two standard drinks per day,

exceeding the lifetime risk guidelines. This was a significant decrease from 200708 (20.9%).

Compared with the national rate, in 201112 a higher proportion of adults drank at risky levels in:

Western Australia (25.3%)

Tasmania (22.8%)

the Northern Territory (24.2%) (these data do not include very remote areas which may affect the

Northern Territory estimates) (see Figure 2.7).

Victoria (17.5%) had a significantly lower proportion of adults drinking at these levels.

Figure 2.7 Adults at risk of long-term harm from alcoho l 200708 to 201112

Notes:

1. Data for the Northern Territory are not comparable over time.


0

10

20

30

40

50


Percen

t200708 201112


35/95



Men and 5564 year olds are more likely to be at risk of long term harm from alcohol

Nationally in 201112, 29.1% of men drank alcohol at levels that put them at risk of long-term harm.

Women (10.1%) were significantly less likely to drink at these levels. This was true in all jurisdictions

(see Figure 2.8), and all age brackets (Figure 2.9).

Adults in the 5564 year old age cohort (23.0%) were significantly more likely to consume alcohol atlevels that put them at risk of long-term harm than younger age groups, except 3544 year olds

(20.5%).

Figure 2.8 Adults at risk of long-term harm from alcoho l by sex, 201112


Figure 2.9 Adults at risk of long-term harm from alcoho l, by age by sex, 201112


0

10

20

30

40

50


Percen

tMen Women

0

10

20

30

40

50

1824 2534 3544 4554 5564 6574 75+

Percen

t

Men Women


36/95


37/95



The combined effect of location and disadvantage varies with each risk factorFor example, in 201112, an adult living in a disadvantaged area:

was much more likely to smoke if they lived outside a major city (30.9%) than if they lived in a

disadvantaged area in a major city (21.9%)

had a similar likelihood of being overweight or obese regardless of whether they lived in or

outside a major city (66.5% compared to 69.3%)

in a major city was significantly less likely to drink at risky levels (12.7%) than anyone else

notably, adults living in disadvantaged areas outside major cities had much higher rates (23.3%).

These combined effects are further shown in the figure below.

Figure 2.12 Smoking, overweight and obesity, and risky drinking , by location by

disadvantage, 201112

H1 Place where the indiv idual lives

Well off area

in a major city

Disadvantaged

area in a major city

Well off area

outside major city

Disadvantaged

area outside a

major city

Compared to the national average

Smoking 10.3% 21.3% 9.5% 30.9%

Excess weight 56.9% 66.5% 67.9% 69.3%

At risk alcohol 21.7% 12.7% 22.4% 23.3%

Key Not significantly different tothe national average

Lower rate than the

national average

Higher rate than the

national average

Notes:

1. Well off areas are those in the 20% least disadvantaged according to the ABS SEIFA, while disadvantaged arethose areas in the 20% most disadvantaged.

2. Differences from the national average are those that are statistically significant.

Source:ABSsee Appendix C.


38/95

Chapter 3: Health system at work38 / HEALTHCARE 201112: COMPARING PERFORMANCE ACROSS AUSTRALIA 2013


39/95

Chapter 3: Health system at work


Chapter 3.

Health systemat workThis chapter reports on key parts of the health system, including primary care,

hospital care and aged care, and focuses on how easily people can access services.


40/95




Section in thi s chapter Performance indicators Outcomes

Waiting times

for General Practitioners

Waiting times for GPs

Australians receive appropriatehigh quality and affordable primaryand community health services

Proportion of people who saw aGP who waited longer than theythought acceptable

Australians have positive healthand aged care experiences whichtake account of individual

circumstances and needs

Elective surgery

waiting times Waiting times for elective surgery

Australians receive appropriatehigh quality and affordable hospitaland hospital related care

Emergency department

waiting times

Waiting times for emergencyhospital care


Differences in the

community

for hospi tal waiting times

Waiting times for elective surgery

Waiting times for emergencyhospital care


Mental healthcare

treatment and follow up

Treatment rates for mental illness

Australians receive appropriatehigh quality and affordable primaryand community health services

Rate of community follow upwithin first seven days ofdischarge from a psychiatricadmission


Rates of

aged care services

Residential and community agedcare places per 1 000 populationaged 70+ years

Older Australians receiveappropriate high quality andaffordable health and aged careservices

Elapsed times for

aged care services

Number of hospital patients days

used by those waiting andeligible for residential aged care

Elapsed time for aged careservices

Older Australians receiveappropriate high quality andaffordable health and aged careservices






that are not included in this report in detail, either due to data quality and availability issues, or

because there was little change in performance year on year.


41/95



Key findingsEmergency department waiting t imes continue to improve after five years of data.

NSW had the highest proportion of patients seen within benchmarks (74%). South Australia improved

the mostfrom 58% in 200708 to 72% in 201112. Nationally, performance increased for patients

from major cities, however it declined for patients from remote areas.

Elective surgery waiting times remain longer than in our f irst report at a national level.

We also found an increasing gap between how long people in the most disadvantaged areas have to

wait for elective surgery compared to people in the least disadvantaged. At both the 50th and 90th

percentiles, this gap increased between 200708 and 201011.

In primary care, most people can see a GP for an urgent appointment with in 4 hours ,but the proportion who wait more than a day was 24.4% in 201112. This is a revised findingsee

the correction at page 43.

In mental health care, we can report good progress on rates of community follow-upafter discharge from psychiatric admission.Nationally and in most jurisdictions, rates have

increased between 200708 and 201011. However, only the ACT has met the notional 75% target

under COAGs National Action Plan on Mental Health (SCOH 2012).

Summary of key findings in this chapter...

Proportion seen within national benchmarksat emergency departments was

70% in 201112

The median waiting time for elective surgeryin public hospitals was 36 days in 201112

Increased by

3 percentage pointsIncreased by

2 days

Proportion waiting more than 24 hours for an

urgent appointment wit h a GP was

24.4% in 201112*

* This is a revised findingsee the correction at

page 43.

Proportion receiving follow up within seven

days of discharge from a psychiatric

admission was 54% in 201011

Increased by

7 percentage points


42/95



Waiting times

for General PractitionersMost people can see a GP for an urgent appointmentwithin four hours. But, there was an increase in theproportion waiting longer than they felt acceptable to see aGP.

Most people can see a GP for an urgent appointment within 4 hours

General practitioners are normally the first healthcare professionals that people see when they have

an illness or injury. Timely access to general practitioners for all people is an important indicator of an

effective and equitable health system. Funding for primary care services is a Commonwealth

Government responsibility (COAG 2008c).

In 201112, most Australians (63.6%) reported that they could see a GP within 4 hours for an urgent

matter. Conversely, more than one third (36.4%) reported having to wait longer than 4 hours.

Figure 3.1 shows that for those waiting longer than four hours, the proportion waiting:

between four and 24 hours was 12.0% of all people

24 hours or longer was 24.4% of all people.

Figure 3.1 How long patients wait for an urgent appointment with a GP


The proportion reporting waiting times for an urgent appointment with a GP:

within four hours was higher in major cities (66.5%) than in other areas (57.3%) of 24 hours or longer was lower in major cities (22.2%) than in other areas (28.7%).

There was no discernable pattern of difference in GP waiting times by socio-economic status.

0 10 20 30 40 50 60 70 80 90 100

201112

Per cent

Within 4 hoursBetween 4

and 24 hours24 hours or longer


43/95



There was an increase in unacceptable waiting times for GPs across Australia

Figure 3.3 shows that the proportion of people who felt they waited an unacceptable time to see a

GP significantly increased from 17.8% in 2009 to 27.4% in 201112. It significantly increased in all

States and Territories except for Western Australia and the ACT. These are large increases in a short

period of time and it would be prudent to treat these results with some caution until future data are

available.

In 201112, the proportion of persons who felt they waited an unacceptable time to see a GP was:

higher in the most disadvantaged areas (29.5%) than the least disadvantaged areas (22.0%)

higher outside of major cities (30.3%) than in major cities (26.1%)

higher for women (29.7%) than men (24.6%).

Figure 3.3 The proportion waiting longer than they felt acceptable for an appointment with

a GP


Correction on waiting times for GPs (issued December 2013)

The original version of this report included data that showed an increase over three years in the

proportion of people waiting longer than 24 hours to see a general practitioner.

This finding was based on data provided to the council by the Steering Committee for the Review of

Government Service Provision, which in turn collated the data from the original data source, the

Australian Bureau of Statistics. The council used this data in accordance with advice provided at the

time on how it may be used.

In September 2013, the ABS corrected its earlier advice to the council, stating that changes in how

the data had been collected across the years meant that it should not be used as a time series.

Accordingly, we have removed our previous finding from this report.

0

5

10

15

20

25

30

35

40

45

50


Percen

t

2009 201011 201112


44/95



Elective surgery

waiting timesFive years of data show lit tle progress on elective surgerywaiting t imes at a national level. NSW was the only State orTerritory where waiting times increased at both the 50thand 90th percentiles. Queensland continues to have theshortest waiting times.

This indicator reports elective surgery waiting times in public hospitals at the 50th and 90th percentile

of the waiting list, including for 15 selected procedures. The waiting time at the 50th percentile (the

median) is the point where exactly half the patients have a shorter wait to be admitted, and half thepatients have a longer wait. Similarly, the 90th percentile waiting time means 90% of patients are

admitted to hospital by this time. For example, a 90th percentile waiting time of 150 days means that

90% of patients were admitted within 150 days.

Waiting times for elective surgery in publ ic hospi tals increased nationally

Figure 3.4 shows at the 50th percentile, the national waiting time increased from 34 in 200708 to

36 days in 201112. Queensland had the shortest time at 27 days, while the ACT had the longest at

63 days. The median waiting time increased in NSW, Victoria and Tasmania, stayed the same in

Queensland and Western Australia and decreased in South Australia, the ACT and Northern Territory.

Figure 3.4 Waiting times for elective surgery at the 50th percentile (median)


Figure 3.5 shows at the 90th percentile, the national waiting time increased from 235 in 200708 to

251 days in 201112. Queensland had the shortest waiting time at 147 days, while Tasmania had the

longest at 348 days. Waiting times at the 90th percentile increased in NSW and Queensland but

decreased in Victoria, Western Australia, South Australia, Tasmania, the ACT and Northern Territory.

0

10

20

30

40

50

60

70

80


Days

50th percentile


45/95



Figure 3.5 Waiting times for elective surgery at the 90th percentile


At the 90th percenti le, waiting t imes increased for four of the 15 selected procedures

Figure 3.6 shows that nationally, waiting times at the 90th percentile increased for four out of the 15

selected procedures. The most common of these procedures was cataract extraction, for which

waiting times increased by 18 days. Waiting times decreased for ten of the 15 procedures at the 90th

percentile, notably for Cytoscopy (the second highest volume procedure) by 49 days.

At the 50th percentile, national waiting times increased for all selected procedures except cystoscopy

(which decreased at the median by 1 day).

In 201112, Australias hospitals admitted about 662 000 patients from elective surgery waiting lists(as either elective or emergency admissions)the 15 select procedures shown below account for

about one-third of total admissions.

Figure 3.6 Change in elective surgery waiting times at the 90th percentile from 200708 to

201112 and number of admissions fo r 15 select p rocedures in 201112


0

50

100

150

200

250

300

350

400

450

500


Days

90th percentile

-47

-21

-65

0

-19

-37

-43

-2

15

-1552

9

-12

-49

18

1,854

3,926

4,307

4,318

4,551

5,821

7,944

9,166

10,413

13,76615,576

16,734

18,967

46,014

61,698

-100 -50 0 50 100

Myringoplasty

Coronary artery bypass graft

Varicose veins stripping & ligation

Haemorrhoidectomy

Septoplasty

Myringotomy

Prostatectomy

Total hip replacement

Hysterectomy

Total knee replacementInguinal herniorrhaphy

Tonsillectomy

Cholecystectomy

Cystoscopy

Cataract extraction

Change in waiting times (days) Admissions


46/95



Emergency department

waiting timesWeve seen sustained improvement over five years of datain emergency department waiting times across all triagecategories. South Australia has shown the strongestimprovementup 14 percentage points.

More emergency department patients treated within national benchmarks

We measure emergency department waiting times in peer group A and B hospitals based on the

percentage of patients seen within five clinically determined triage categories. We look particularly attriage categories 2 and 3 because 100% of patients are seen on time in category 1. We acknowledge

performance at categories 4 and 5 may be affected by the availability of primary carewhich is

mainly a Commonwealth Government responsibility.

Figure 3.7 shows the proportion of emergency department patients seen within national benchmarks,

across all triage categories, increased from 67% nationally in 200708 to 70% in 201112.

In 201112, NSW had the highest proportion of patients seen within benchmarks (74%) while the

Northern Territory had the lowest (46%). South Australia showed the strongest improvement over the

periodfrom 58% in 200708 to 72% in 201112.

Figure 3.7 Proportion of emergency department patients treated with in national

benchmarks, all triage categories


0

10

20

30

40

50

60

70

80

90

100


Per cent


47/95



There were good improvements in triage categories 2, 3, 4 and 5

Figures 3.8 and 3.9 show that from 200708 to 201112, most governments increased performance

in the proportion of triage categories 2, 3, 4 and 5 patients seen within benchmarks.

Queensland had the largest improvement for triage category 2 (13 percentage points).

Queensland (with NSW and Victoria) now has the highest proportion in triage category 2 at 82%.

South Australia had the largest improvement for triage category 3 (15 percentage points). Victoria

has the highest proportion in triage category 3 at 71%.

South Australia had the largest improvement for triage category 4 (17 percentage points). South

Australia (with NSW) now has the highest proportion in triage category 4 at 72%.

Western Australia had the largest improvement for triage category 5 (11 percentage points).

Western Australia now has the highest proportion in triage category 5 patients at 93%.

Figure 3.8 Change in performance in triage categor ies 2 and 3 from 200708 to 201112


Figure 3.9 Change in performance in triage categor ies 4 and 5 from 200708 to 201112


-5

0

5

10

15

20

NSW

Vic

Qld

WA

SA

Tas

ACT

NT

Aus

t

NSW

Vic

Qld

WA

SA

Tas

ACT

NT

Aus

t

Triage category 2 Triage category 3

Percentage point s

-5

0

5

10

15

20

NSW V

icQld

WA

SA

Tas

ACT

NT

Aus

t

NSW V

icQld

WA

SA

Tas

ACT

NT

Aus

t

Triage category 4 Triage category 5

Percentage points


48/95



Differences in the community

for hospital waiting timesElective surgery waiting times are longer for those living inthe most disadvantaged areas, for Indigenous Australians,and for most areas of greater remoteness.

People living in the most disadvantaged areas wait longer for elective surgery and the

gap is widening

In 201011, waiting times at the 50th percentile were 11 days shorter in the least disadvantaged

areas (30 days) than in the most disadvantaged areas (41 days). Waiting times at the 90th percentile

were 102 days shorter in the least disadvantaged areas (184 days) than in the most disadvantagedareas (286 days).

Figure 3.10 shows this gap in waiting times between people from the least disadvantaged areas and

most disadvantaged areas has been increasing over time. At the 50th percentile, the gap increased

from 8 days in 200708 to 11 days in 201011. At the 90th percentile, the gap increased from 50

days in 200708 to 102 days in 201011.

Figure 3.10 Number of extra days people in the most disadvantaged areas wait for elective

surgery compared to people from the least disadvantaged areas

Notes:

1. Different scale on left hand side for 50th percentile and right hand side for 90th percentile.


0

20

40

60

80

100

120

0

2

4

6

8

10

12 DaysDays 50th percent ile 90th percentile


49/95



Increasing gap in median elective surgery waiting t imes between Indigenous and

nonIndigenous Australians

In 201011, Indigenous Australians waited 3 days longer at the 50th percentile for elective surgery

(39 days) than non-Indigenous Australians (36 days). The gap was larger in inner regional and very

remote areas (6 and 7 days respectively), than in major cities and outer regional areas (3 and 1 days

respectively). In remote areas, nonIndigenous Australians waited 1 day more than Indigenous

Australiansit will be interesting to see if this pattern is repeated in future years (Figure 3.11).

Figure 3.11 Number of extra days Indigenous elective surgery patients wait compared to

non-Indigenous patients at the 50th percentile, by remoteness of patient


Waiting times are improving for patients in major citi es, but getting worse for patientsin remote areas

Figure 3.12 shows that nationally, the proportion of emergency department patients from major cities

treated within benchmarks improvedfrom 65% to 69%. For people living in remote areas, the

proportion treated within national benchmarks fell from 74% to 70%. There was no discernable

pattern of difference by Indigenous status or socio-economic status.

Figure 3.12 Proportion of emergency department patients treated with in national

benchmarks by remoteness of patient


-5

0

5

10

15

20

Major cities Inner reg ional Outer reg ional Remote Very remote

Days

200809 200910 201011

50

60

70

80

Major cities Inner reg ional Outer reg ional Remote Very remote

Percen

t

200708 200809 200910 201011 201112


50/95



Mental healthcare

treatment and follow upTreatment rates for mental health are increasing, as arerates of community follow up after psychiatric discharges.

Increase in cl inical mental health services under the Medicare Benefits Scheme or

from the Department of Veterans Affairs

While we do not know what the level of need is for mental health services, COAGs Roadmap for

National Mental Health Reform 20122022 includesa preliminary treatment rate target of 12% of the

population (COAG 2012). This does not distinguish between public clinical mental health services

(public), psychiatric care in private hospitals (private), or services covered under the Medicare Benefit

Scheme and by the Department of Veteran Affairs (MBS and DVA).

In this section, we choose to focus on MBS and DVA clinical mental health services (Commonwealth

funded). Rates of public (State and Territory funded) and private services have been relatively stable

at 1.6% and 0.1% respectively over 200708 to 201011.

Figure 3.13 shows the proportion of people receiving clinical health services covered under the

Medicare Benefit Scheme (MBS) and by the Department of Veteran Affairs (DVA) has increased from

4.9% in 200708 to 6.9% in 201011. The increase was across all States and Territories.

The more remote an area, the fewer people receive Medicare or DVA supported clinical mental health

services. The rates in major cities and inner regional areas (7.3% and 7.1%) are more than twice as

high as in remote areas (3.0%) and in very remote areas (1.9%).

Figure 3.13 Population receiving MBS and DVA clinical mental health service prov ision, by

type of service

Sources: State and Territory community mental health care data; Private Mental Health Alliance Centralised Data ManagementService; Department of Health and Ageing (DoHA) Medicare data and Department of Veterans Affairs datasee Appendix C.

0

1

2

3

4

5

6

7

8

9

10

Psychiatrist Clinical psychologist GP Other all ied health Total MBS and DVA

Percen

t

200708 200809 200910 201011


51/95


52/95



Rates ofaged care servicesThe number of aged care places per 1000 older Australianshas increased over time, except in very remote areas.Growth appeared to stall in the most recent year.

Increasing rate of community care places is driving overall growth in aged care

The Commonwealth Government is responsible for funding and regulating residential and community

aged care places for people aged 65 years and over (50 years and over for Indigenous Australians)

(COAG 2011). Growth in the number of places is linked to a target provision ratio of 113 places

available per 1000 persons aged 70 and over (88 for residential care and 25 for community care).

Figure 3.15 shows the rates of aged care places in all States and Territories from 2009 to 2012.

The ACT had the highest rate of aged care places (117 places per 1000 older population) in 2012,

driven by increases in previous years in the rate of community places.

From 2009 to 2012:

the national rate of aged care places per 1000 older people has increased from 108.1 in 2009 to

110.2 in 2012 (made up of 81.9 residential places and 28.3 community places per 1000)

the rate of residential care declined in all States and Territories except the ACT, while community

care places have increased

the total rate increased in all jurisdictions except South Australia, Tasmania and the NorthernTerritory.

While total rates of aged care services increased in the four years to 2012, it should be noted that the

rate fell in most jurisdictions between 2011 and 2012 as the continuing decrease in residential

services was not compensated for by an increase in community care. The national rate of residential

and community care combined fell from 111.0 to 110.2 services per 1000 older Australians.

Figure 3.15 Aged care places per 1000 older people, 2009 to 2012

Source: Commonwealth Department of Health and Ageing (DoHA) Ageing and Aged Care data warehousesee Appendix C.

0

20

40

60

80

100

120

140


Per 1000 Residential Community Total

20

09

2

012

2011

2010


53/95



Widening gap in aged care places for older people living in major cites and remote

areas

The rate of aged care services declines as remoteness increases. The service mix also varies, with

community service places becoming more prevalent as remoteness increases.

Figure 3.16 shows the total rate of residential and community aged care services by remoteness

areas in each year from 200809 to 201112, as well as the rates by service type.

Despite already having the highest rates for residential places, the largest increases have been in

major cities and inner and outer regional areas, rather than remote and very remote areas.

In remote areas, the total rate of services per 1000 older people increased by 0.4% from 200809 to

201112, while it fell 6.4% in very remote areas.

Figure 3.16 Rates of aged care places per 1000 older Australians by area of remoteness

Source: Commonwealth Department of Health and Ageing (DoHA) Ageing and Aged Care data warehousesee Appendix C.

200809

200910

201011

201112

0

20

40

60

80

100

120

Major c ities Inner reg ional Outer reg ional Remote Very remote

Per 1000 populationResidential Community


54/95



Elapsed times for

aged care servicesPeople take longer between assessment and entering acare service, though fewer days are spent waiting inhospital by those needing aged care.

Increased elapsed time between Aged Care Assessment Team approval and entering

high residential care

As there can be a range of reasons why an individual may have a long elapsed time for aged care

servicesincluding where an individual chooses not to use a servicewe have focused on high care

residential services. This is where elapsed time is more likely to reflect an actual waiting time. Wefocus on four of the five time periods (data are also available for within two days).

Figure 3.17 shows that for individuals who entered residential high care:

the proportion who entered within seven days fell from 26.3% in 200809 to 22.6% in 201112

the proportion who entered high care within 9 months of their ACAT assessment fell from 96.7%

to 87.3%or put another way, the proportion of individuals who took longer than nine months to

get into high residential care increased from 3.3% to 12.7%.

Figure 3.17 Proportion of people assessed by ACAT who enter high residential care with in

select t ime per iods, 200809 to 201112

Source: Commonwealth Department of Health and Ageing (DoHA)see Appendix C.

People take longer to get into services in more remote areas

In

healthcare 2011-12: comparing performance across australia

Documents