Admitted patient palliative care and hospital-based facilities

This section presents information on episodes of admitted patient palliative care occurring in hospitals, using data on palliative care-related hospitalisations from the National Hospital Morbidity Database (NHMD). The NHMD is a collation of data about admitted patient care in Australian hospitals, based on the Admitted Patient Care National Minimum Data Set. Further information can be found in the data sources section.

Information is presented on hospitalisations for which palliation was provided. Time series data for the period from 2012–13 to 2016–17 are presented to show the changes in hospitalisations for palliative care over this period. Wherever possible, corresponding data on all hospitalisations have been provided for comparative purposes.

This section also presents information on public acute and private hospital-based hospice care units.

Data downloads

Admitted patient palliative care and hospital-based facilities tables 2016–17 (538KB XLS)

Admitted patient palliative care and hospital-based facilities section 2016–17 (538KB)

The information in this section was last updated in May 2019.

Key points

  • 77,369 palliative care-related hospitalisations were reported from public acute and private hospitals in Australia in 2016–17.
  • 53.1% of palliative care-related hospitalisations were for people aged 75 and over.
  • 25.6% increase in palliative care-related hospitalisations between 2012–13 and 2016–17, compared to a 17.6% increase in hospitalisations for all reasons over the same period.
  • 51.6% of all hospitalisations in which the patient died, the patient had received palliative care in 2016–17.
  • 46.7% of palliative care hospitalisations involved cancer as the principal diagnosis in 2016–17.
  • 133 public acute hospitals reported that they had a hospice care unit in 2016–17, and about a third (31.6%) were located in New South Wales.
  • 1 in 5 (19.8%) of the 673 public acute hospitals (excluding public psychiatric hospitals) in Australia had a hospice care unit in 2016–17.

 

A palliative care-related hospitalisation is defined as an episode of admitted patient care for which the principal clinical intent was palliation during all or part of that episode. Two NHMD data items—Care type and Additional diagnosis—are used to capture information on palliative care: if either (or both) has a code of ‘palliative care’, that hospitalisation is considered in scope (see Identifying palliative care hospitalisations for further information). 

Admitted patient palliative care in 2016–17

In 2016–17, there were 77,369 palliative care-related hospitalisations reported from public acute and private hospitals in Australia, accounting for about 1 in 140 (0.7%) of all hospitalisations (11.0 million). A higher proportion of palliative care-related hospitalisations were for males (53.5%) than females (46.5%), and the rate was also higher for males than females (34.2 and 29.3 per 10,000 population, respectively).

People aged 75 and over accounted for over half (53.1%) of all palliative care-related hospitalisations in 2016–17; the average patient age of all palliative care hospitalisations was 73.1 with little difference between the sexes. This was considerably older than the average age of 55.0 years for hospitalisations for all reasons. Only about 1 in 10 (10.5%) of the total number of palliative care-related hospitalisations was for patients aged under 55.

The population rates of palliative care-related hospitalisations for males and females were similar up until age 55, from which point men had higher rates of palliative care, with the difference between the sexes becoming greater with increasing age. For those aged 85 years and over, males had a palliative care-related hospitalisation rate of 500.2 per 10,000 population, compared to 333.4 for females, even though the number of palliative care hospitalisations in this age group was higher for females than males, reflecting females higher average life expectancy compared to males.

Profile of palliative care-related hospitalisations in 2016–17

Where was palliative care provided?

In 2016–17, similar to previous years’ findings, a high proportion of palliative care-related hospitalisations were recorded from public hospitals (84.6% or about 65,500 hospitalisations), compared to 59.8% of all hospitalisations. For states and territories where private sector data were able to be published, the highest proportions of hospitalisations in public hospitals were in New South Wales (95.3%) and Victoria (88.2%) with the lowest in Western Australia (64.7%).

Tasmania reported the highest population rate at 42.2 palliative care-related hospitalisations per 10,000 population for public hospitals, followed by the Australian Capital Territory (30.6) (Figure APC.1). Western Australia had the lowest population rate within public hospitals, at 17.7 palliative care-related hospitalisations per 10,000 population. In those states where private sector data were able to be published, Western Australia reported the highest rate (9.6 per 10,000 population) for palliative care-related private hospitalisations, about 7 times higher than the rate for New South Wales (1.4). For those states and territories where all hospitalisations were able to be published, South Australia had the highest rate of palliative care-related hospitalisations in all hospitals (38.5 per 10,000 population), followed by Victoria (34.6). Western Australia had the lowest overall rate for all hospitals (27.3).

 
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Figure APC.1 Alternative text - Source data: Admitted patient palliative care and hospital-based facilities tables (538KB XLS)

How long did patients stay?

In 2016–17, almost all (95.0%) palliative care-related hospitalisations involved an overnight hospital stay, compared with 39.6% for all hospitalisations (AIHW 2018). Palliative care-related hospitalisations accounted for about 791,740 patient days, with an average length of stay (ALOS) of 10.2 days—almost 4 times as long as the ALOS of 2.8 days for all hospitalisations. When only those hospitalisations that involved an overnight stay are considered, the difference narrows to 10.7 days for palliative care-related hospitalisations and 5.6 days for all hospitalisations (AIHW 2018). The total ALOS per palliative care-related hospitalisation which included same day separations was 9.9 days for males and 10.6 days for females.

The average length of stay was longer in private than public hospitals for all jurisdictions where private hospitals data can be reported, with the exception of South Australia. The greatest difference was in Queensland, with a 5.0 day longer ALOS in private compared to public hospitals (Figure APC.2) in 2016–17. The ALOS in public hospitals for overnight hospitalisations was highest in the Northern Territory (10.9 days). For private hospitals, South Australia recorded the highest overnight ALOS, at 15.9 days. Nationally, ALOS was higher in private (13.3 days) than public hospitals (10.3 days) for overnight hospitalisations.

 
Visualisation not available for printing

Figure APC.2 Alternative text - Source data: Admitted patient palliative care and hospital-based facilities tables (538KB XLS)

Who paid for the care?

In 2016–17, public patient funding accounted for 76.5% of palliative care-related hospitalisations in public hospitals; private health insurance was the next most common funding source (19.4%). By comparison, public patient funding for all hospitalisations in public hospitals was 83.0% and private health insurance 13.8%.

In private hospitals, private health insurance was the funding source for 69.2% of palliative care-related hospitalisations, compared with 82.7% of all hospitalisations. Public patient funding was more likely for palliative care-related hospitalisations in private hospitals (17.9%) than all hospitalisations (4.5%), and less likely to be funded by private health insurance (69.2% compared with 82.7%).

The funding pattern for public hospitals differed across jurisdictions: in New South Wales, 68.7% of palliative care-related hospitalisations were public patients compared with 88.4% in the Northern Territory. Private hospitals also varied, with 45.3% of palliative care-related hospitalisations funded as public patients in Western Australia compared with 0.9% in Victoria.

How was the care completed?

The ‘mode of completing a hospitalisation’ indicates the status of a patient at the end of the hospitalisation; for example, whether the person died, or their destination after discharge from hospital.

More than half of all palliative care-related hospitalisations ended with the patient’s death (52.3%), compared with less than 1 in a hundred (0.7%) for all hospitalisations. The next most common reason for completing hospitalisation was ‘other’ (28.7% i.e. discharge to own accommodation, usual residence or welfare institution), followed by transfer to another acute hospital (7.9%). Patterns of completed palliative care-related hospitalisations were similar across both public and private hospitals. However, jurisdictional differences were evident within and across sectors. The proportion of palliative care-related hospitalisations in public hospitals ending with the patient’s death was lowest in the Northern Territory (42.9%) and highest in Queensland (56.0%). For private hospitals where state or territory data were able to be published, Western Australia reported the highest percentage of hospitalisations ending with the patient’s death (63.7%), which was higher than the national average for the sector (53.5%). Palliative care patients from private hospitals were more likely to be transferred to another hospital in New South Wales and Victoria compared with other jurisdictions reported.

Characteristics of admitted palliative care patients

This section presents information on the number and proportion of palliative care-related hospitalisations for various demographic groups.

Socioeconomic status

Socioeconomic status generally refers to the level of economic and social resources of an individual (such as income, education and employment) and it is well established that it is associated with health outcomes (AIHW 2016). The Index of Relative Socio Economic Disadvantage (IRSD) is used here to indicate socioeconomic status of the area in which the individual lives.

In 2016–17, people living in areas classified as having the lowest socioeconomic status (Quintile 1) accounted for a higher proportion of palliative care-related hospitalisations (22.3%) in public hospitals than those living in other areas. The rate of palliative care-related public hospitalisations was also highest for those living in these areas (35.6 per 10,000 population). Conversely, the rate of public palliative care-related hospitalisations was lowest for those living in the highest socioeconomic status areas (17.7 per 10,000). These patterns are similar to those for all hospitalisations.

An opposite pattern is apparent for palliative care-related hospitalisations in private hospitals, where the rate was highest for those living in the highest socioeconomic status areas (6.7 per 10,000 population). This pattern was also seen for all private hospitalisations for this socioeconomic group (2,440.6 per 10,000 population). In addition to accessing private hospitals for palliative care, higher socioeconomic status individuals may also be accessing other types of non-admitted patient palliative care e.g. from private, freestanding hospice care facilities or community based palliative care services.

Indigenous status

Aboriginal and Torres Strait Islander people are disadvantaged relative to other Australians across a range of health-related and socioeconomic indicators (AIHW 2015a ). This may affect their use of, and access to, admitted patient palliative care.

A total of 1,557 palliative care-related hospitalisations for Indigenous Australians were reported in 2016–17, with the majority (95.4%) occurring in public hospitals. There were a similar number of hospitalisations for Indigenous males and females, whereas there were more hospitalisations for other Australian males than females. The rate of palliative care-related hospitalisations in public hospitals is about twice as high for Indigenous Australians as for other Australians (45.6 and 23.3 per 10,000 population, respectively) with the rate of all public hospitalisations 3.8 times higher for Indigenous Australians than other Australians.

Remoteness of patient’s usual residence

As would be expected, most palliative care-related hospitalisations in 2016–17 across both public and private hospital sectors were for patients whose usual residence was in Major cities (68.1%), with the proportion of palliative care-related hospitalisations decreasing as remoteness increased. However, the population rate for Major cities public hospital hospitalisations of 25.5 per 10,000 population, was lower than the rate for Inner regional (30.4 per 10,000) and Outer regional areas (32.3 per 10,000).

Males accounted for a greater proportion of the palliative care-related hospitalisations than females in all remoteness categories for both public and private hospitals.