Access to hospitals

Providing access to appropriate and timely hospital care is an integral component of health care. In essence, it is about being able to get the health care you need, when you need it.

A person’s ability to access appropriate and quality health care is influenced by their own health needs as well as factors such as where they live, their socioeconomic circumstances, and their cultural background (WHO 2006).

This report explores hospital accessibility by looking at the:

  • number of services available, including hospitals and emergency departments
  • location of services and hospitals
  • waiting times to access elective surgery and emergency department care
  • geographic location, socioeconomic disadvantage and Indigenous status of the people who use hospital services.

Where are hospitals and beds located?

The number and type of hospitals, and the beds available, are measures of access to health care services. Public hospitals in Major cities are more likely to be larger and to offer a broader range of services, whereas hospitals in more remote areas tend to be smaller and offer a smaller range of services. This can affect the timeliness and availability of services for people living in more remote areas.

In 2019–20, there were 695 public hospitals which varied in terms of location, size, and services provided. Of these public hospitals, 182 were in Major cities, 402 were in Inner regional and Outer regional areas, and 111 were in Remote or Very remote areas.

There were 62,575 public hospital beds available, on average, in 2019–20—representing 2.5 beds per 1,000 population and ranging from 2.3 per 1,000 population in Major cities to 4.1 per 1,000 population in Remote and Very remote areas. Just over two-thirds (67%) of the hospital beds in Australia were in Major cities.

Since 2015–16, the beds per 1,000 population in public hospitals has fallen by an average of 0.9% every year.

Most of the larger public hospitals were located in the more populated areas, and this is evidenced by the number of hospital beds that were located in each remoteness area. Although 26% of hospitals are in Major cities, 67% of hospital beds are located in Major cities, 58% of hospitals and 30% of hospital beds are in Inner and Outer regional areas, and 16% of hospitals and 3.2% of hospital beds in Remote and very remote areas.

Access to admitted patient care

In 2019–20, hospitalisation rates varied across levels of socioeconomic disadvantage and remoteness for public and private hospitals.

For public hospitals, the highest rates of hospitalisation were for patients living in the most disadvantaged areas (303 hospitalisations per 1,000 population) with rates decreasing as the level of disadvantage decreases. For private hospitals, the highest rates were for patients living in the least disadvantaged areas (221 hospitalisations per 1,000 population) with hospitalisation rates decreasing as the level of disadvantage increases.

Patterns of hospitalisations also varied by remoteness area; the highest rates of hospitalisation in private hospitals were for patients whose area of residence was in Major cities, whereas the highest rates of hospitalisations in public hospitals were for patients whose area of residence was in Very remote areas. Hospitalisations in public hospitals increase with increasing remoteness of the patient’s area of residence, while hospitalisations in private hospitals decrease with increasing remoteness of the patient’s area of residence.

The bar chart shows the number of hospitalisations for public and private hospitals by socioeconomic status and remoteness in 2019–20. Generally, the number of hospitalisations per 1000 population decreased for public hospitals and increased for private hospitals as the level of disadvantage decreases. Also, the number of hospitalisations per 1000 population generally increased for public hospitals and decreased for private hospitals as the level of remoteness increases.

Access to emergency department care

Waiting times

How long people spend waiting in the emergency department before they receive care (waiting time) can be used as a measure of the accessibility of emergency department care.

Waiting time statistics are presented here as:

  • the 50th percentile (median) waiting time, which represents the time before which half of people are seen.
  • proportion seen on time.

Emergency department waiting time measures represent the time elapsed from presentation to commencement of clinical care.

The diagram illustratively shows the waiting time and length of time spent in emergency department. The diagram is broken down into different stages of presentation, triage, a commencement of clinical care, end of clinical care and physical departure. In the diagram, the waiting time starts at presentation and ends at the commencement of clinical care. Whilst the time spent in emergency department starts at presentation and ends at physical departure.

In 2020–21, 50% of patients were seen within 18 minutes. This has stayed relatively consistent since 2016–17, when 50% of patients were seen within 19 minutes.

In 2020–21, 71% of presentations to emergency departments were ‘seen on time’ (down from 74% in 2019–20)—ranging from 100% of patients requiring immediate care (Resuscitation) to 63% of patients who needed care within 30 minutes (Urgent).

Another measure of access to services is the total time a patient spends in the emergency department. In 2020-21, 50% of emergency department presentations were completed within 3 hours 1 minute, and 90% were completed within 8 hours.

For patients who were not subsequently admitted to hospital, 90% completed their care within 5 hours 53 minutes, but for patients subsequently admitted to hospital, 90% completed their care within 12 hours 57 minutes.

The time in which 90% of patients spent in the emergency department also varied by triage category—ranging from 3 hours and 36 minutes for patients who needed care within 120 minutes (Non-urgent) to 11 hours and 35 minutes for patients requiring immediate care (Resuscitation).

Access to surgery

People can be admitted to hospital for emergency surgery, or for less urgent procedures they can be booked in as part of an ‘elective’ admission to hospital (elective in this context refers to there being some flexibility around the timing of the procedure, not whether the procedure itself is optional.). Access to surgical services can be affected by issues such as the person’s geographical location, the availability of other healthcare services, and how many people are on public hospital elective surgery waiting lists.

Emergency hospitalisations involving surgery

In 2019–20, 367,574 hospitalisations were emergency admissions that involved surgery—87% (318,132) were in public hospitals and 13% (49,442) were in private hospitals. The three most common reasons for emergency admissions involving surgery were appendicitis, fractured femur and heart attack.

People living in Very remote areas were twice as likely to have an emergency admission involving surgery as people living in Major cities (26 compared with 13 hospitalisations per 1,000 population).

Elective hospitalisations involving surgery

In 2019–20, 2.1 million hospitalisations were elective admissions involved surgery—66% (1.4 million) were in private hospitals and 33% (714,000) were in public hospitals. The three most common reasons for elective admissions involving surgery were cataracts, skin cancer and retinal disorders.

People living in Major cities were nearly one and a half times as likely to have an elective admission involving surgery as people living in Very remote areas (77 compared with 52 hospitalisations per 1,000 population).

Admissions from public hospital elective surgery waiting lists

In 2020–21, 754,600 patients were admitted for elective surgery from public hospital waiting lists. Removal of cataracts was the most common procedure (9.7%), followed by Cystoscopy (9.0%). The most common surgical specialty was General surgery (20%), followed by Urological surgery (15%) and Orthopaedic surgery (14%).

People living in Remote areas had the highest rate of admission from a public hospital waiting list (35.2 hospitalisations per 1,000 population) followed by people living in Outer regional and Inner regional areas (32.5 and 33.1 per 1,000 population respectively). People living in Major cities had the lowest rate of admission from public hospital waiting lists for elective surgery (23.4 hospitalisations per 1,000 population).

Waiting times for admission to elective surgery

In 2020–21, 50% of patients admitted to hospital from public hospital elective surgery waiting lists waited for 48 days or less, and 90% waited for 348 days or less. Also:

  • 7.6% of people admitted for surgery waited more than 365 days compared to 2.8% just a year before.
  • 50% of Aboriginal and Torres Strait Islander people were admitted to hospital within 57 days, whereas 50% of Other Australians were admitted within 48 days
  • the time within which 50% of patients were admitted for their awaited procedure ranged from 34 days in Remote areas to 45 days in Outer regional areas  for the 25 most common intended procedures.
  • the time within which 50% of patients were admitted ranged from 32 days for patients living in the least disadvantaged areas to 43 days for people living in the most disadvantaged socioeconomic areas for the 25 most common intended procedures.

Between 2016–17 and 2020–21, the 50th percentile waiting time increased overall from 38 days to 48 days and the 90th percentile waiting time increased overall from 258 days to 348 days.

In part, waiting times for elective surgery were affected by restrictions placed on elective surgeries that were introduced as a response to COVID-19 (see Impact of COVID-19 on hospital care section below).

Where to go for more information

Admitted patient access - Australian Institute of Health and Welfare

Elective surgery access - Australian Institute of Health and Welfare

Emergency department care access - Australian Institute of Health and Welfare