Summary
Hospitals, beds and staff
There were 727 public acute hospitals, including 23 public psychiatric hospitals operating in Australia in 1996–97. Two thirds of public hospitals in 1996–97 were smaller hospitals of up to 50 beds.
Public hospitals across Australia had an average of 3.1 available beds per 1,000 population, down from 3.3 per 1,000 in 1995–96. By broad geographic type, the available beds per 1,000 population ranged from 2.8 in metropolitan centres, through 3.7 in rural areas, to 4.6 in remote areas.
Nurses made up 44% and salaried medical officers 8% of total full time equivalent staff of public hospitals. Salaries and wages paid to all staff were 64% of total recurrent expenditure of $12.2 billion in 1996–97. A further 9% was made up by superannuation payments and payments to visiting medical officers.
Patient numbers and lengths of stay
The throughput of patients of both public and private hospitals continued to increase. Separations from public acute hospitals grew from 1995–96 to 1996–97 by 2% to over 3.6 million or 197 per 1,000 population. Private hospitals showed a 7% increase, to 1.7 million or 92 per 1,000 population. Thus private hospitals increased their share of patient separations to 32% overall.
Numbers of patient days in public acute hospitals fell by 3% to 15.2 million. Private hospital patient days fell by 1% to 5.8 million. The private hospital share of all hospital patient days thus rose to 26%.
An increase in throughput and a decrease in numbers of patient days was expressed also in a continued decline in average lengths of stay in hospitals. Overall, average lengths of stay dropped from 4.3 to 4.2 days from 1995–96 to 1996–97. Private hospital stays averaged 3.5 days compared with 4.2 in public acute hospitals. A factor in this decline is increasing proportions of patient separations that are same day separations. These increased to 42% in public acute hospitals and to 51% in private hospitals. Public psychiatric hospitals continued to have high average lengths of stay— 68 days for separations during 1996–97.
The number of separations of private patients in public acute hospitals has been in decline for several years. In 1996–97, 10.9% of public hospital patients were private patients, down from 16.5% in 1993–94.
Patient Characteristics
Age and sex
Females accounted for higher proportions of separations than males, 53% of total separations in public hospitals (1.9 million) and 56% in private hospitals (1.0 million). In both public and private hospitals, there were more separations for females than males in all age groups from 15 to 54 years and in the 75 years and over age groups.
For all hospitals, the population in age groups over 65 years, which comprised 12% of the total Australian population, accounted for 30% of separations (1.6 million) and 46% of patient days (10.2 million). There were 727 separations per 1,000 population for this age group compared with an overall crude rate of 289 per 1,000 for the total population. The average length of stay for these patients was 6.3 days, compared with 4.2 days for all patients.
Indigenous status
There were 144,485 separations for patients reported as Aboriginal or Torres Strait Islander. On an age-standardised basis, separations for Aboriginal or Torres Strait Islander patients were 86% higher (531 per 1,000) than for the overall Australian population (285 per 1,000). It is likely that identification of Aboriginal and Torres Strait Islander patients is incomplete and that these figures are underestimates.
Morbidity
Principal diagnoses in the National Health Priority Areas of Cardiovascular health, Cancer control, Injury prevention and control, Mental health and Diabetes accounted for over 9 million patient days, or 41% of total patient days in all hospitals during 1996–97. Mental disorders (2.9 million patient days) and Cardiovascular disease (2.5 million patient days contributed most to this total. Although patient days associated with Diabetes as a principal diagnoses (167,811) were far fewer than for other National Health Priority Areas, Diabetes was significant as an additional diagnosis, bringing the number of patient days with which it is associated to 2.2 million.
The most common Australian National Diagnosis Related Group (AN-DRG) in public hospitals in 1996–97 was Admit for renal dialysis (AN-DRG 572), accounting for 9.8% of total separations. Other leading AN-DRGs included Chemotherapy (AN-DRG 780) with 3.7%, and Vaginal delivery without complicating diagnosis (AN-DRG 674) with 3.2% of total public hospital separations. The corresponding top three AN-DRGs in the private sector were Other gastroscopy for non-major digestive disease without complications and co-morbidities (AN- DRG 332), with 6.1% of total separations, Other colonoscopy without complications and co- morbidities (AN-DRG 335), with 5.5%, and Lens procedures without vitrectomy and without complications and co-morbidities (AN-DRG 099), with 3.6%.