Hospitals – Admitted patient palliative care

In 2021–22, there were 94,800 hospitalisations where palliative care was provided during all or part of the episode of care in Australia. This section provides information related to these hospitalisations and the characteristics of people admitted for palliative care over the period 2015–16 to 2021–22. It also presents information on expenditure for palliative care in public hospitals. Further information on hospitalisations for palliative care can be found in Data sources and Technical information: Identifying palliative care-related hospitalisations.

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

Key points

In 2021–22, among 94,800 palliative care-related hospitalisations based on data from the National Hospital Morbidity Database:

  • more than half (53%) were for males
  • almost 3 in 5 (58%) were for people aged 75 and over
  • 51,300 were for primary palliative care and 43,500 for other palliative care, equating to 19.9 and 16.9 per 10,000 population, respectively
  • 2 in 5 (40%) had a principal diagnosis of cancer – 1 in 2 (49%) for primary palliative care hospitalisations and almost 1 in 3 (29%) for other palliative care hospitalisations
  • average length of stay was almost twice as long as for all overnight hospitalisations (hospitalisations that exclude same-day stays) – 10.3 days (9.3 days for primary palliative care and 11.5 days for other palliative care) compared with 5.7 days for all hospitalisations
  • 2 in 3 (67%) primary palliative care hospitalisations ended with the patient dying in hospital compared with 43% for other palliative care hospitalisations.

Between 2015–16 and 2021–22, there was a 29% increase in the number of palliative care-related hospitalisations – this increase was at a steeper rate than for all hospitalisations (10% increase) over the same period.

Based on data from the National Hospital Cost Data Collection, the total palliative care expenditure in public hospitals was $481.4 million (19% of all sub-acute care costs or 1.1% of total cost in these public hospitals) in 2020–21. The average cost per palliative care episode was $13,300 and per palliative care phase was $7,800.

Characteristics of people hospitalised for palliative care

In 2021–22, there were 11.6 million hospitalisations across Australia, including 94,800 hospitalisations where palliative care was provided during all or part of the episode of care (referred to as palliative care-related hospitalisations, see Identifying palliative care in hospital data for further details). More than half of these hospitalisations (54% or 51,300) had a care type of palliative care (referred to as primary palliative care hospitalisation), while 43,500 had a diagnosis of palliative care but the type of care delivered was not recorded as palliative care (referred to as other palliative care hospitalisation). This equates to 19.9 primary palliative care hospitalisations per 10,000 population and 16.9 other palliative care hospitalisations per 10,000 population, respectively (Table APC.1).

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

In 2021–22, among 94,800 palliative care-related hospitalisations (Figure APC.1):

  • Males accounted for over half (53%) – a different pattern to that for hospitalisations for all reasons where females accounted for more than half (52%; Table APC.1).
  • Almost 3 in 5 (58%) were for people aged 75 and over – the average age at admission for palliative care-related hospitalisations was 75 years. This is considerably older than for hospitalisations for all reasons (56 years). Less than 1 in 10 (8.4%) palliative care-related hospitalisations were for people aged under 55 (Table APC.1).
  • 2,500 Aboriginal and Torres Strait Islander (First Nations) people had a palliative care-related hospitalisation. The majority of these hospitalisations occurred in public hospitals (95%) – a higher proportion than for all hospitalisations (86%; Table APC.2). 
  • People living in the lowest socioeconomic areas had hospitalisation rates in public hospitals twice as high as those in the highest socioeconomic areas – 43 compared with 22 per 10,000 population. Conversely, in private hospitals people living in the highest socioeconomic areas had palliative care-related hospitalisation rates 2.5 times as high as those in the lowest socioeconomic areas (8.6 compared with 3.5 per 10,000 population, respectively). These overall patterns were also observed for hospitalisations for all reasons (Table APC.3). 

Figure APC.1: Demographic and geographical characteristics of people hospitalised for palliative care, 2021–22

Figure 1.1: The interactive data visualisation shows the number and rate of primary palliative care hospitalisations and other palliative care hospitalisations by age group in 2021–22. The number of primary palliative care hospitalisations was highest among those aged 75–84, while the number of other palliative care hospitalisations was highest among those aged 85 and over. The rate (per 10,000 population) of hospitalisations generally increased with increasing age for both primary palliative care and other palliative care, with the highest rate for those aged 85 and over. 

­­Figure 1.2: The interactive data visualisation shows the number and rate of primary palliative care hospitalisations and other palliative care hospitalisations by socioeconomic areas and sector in 2021–22. The number and rate (per 10,000 population) of primary palliative care and other palliative care hospitalisations in public hospitals decreased by increasing socioeconomic areas (1 lowest to 5 highest), while the reverse was observed in private hospitals.

Figure 1.3: The interactive data visualisation shows the number and rate of primary palliative care hospitalisations and other palliative care hospitalisations by remoteness areas and sector in 2021–22. For both hospitalisations, the number in public and private hospitals, and the rate (per 10,000 population) in private hospitals decreased by increasing remoteness areas (Major cities to Remote and Very remote areas combined).

Figure 1.4: The interactive data visualisation shows the number and rate of primary palliative care hospitalisations and other palliative care hospitalisations by states and territories and sector in 2021–22. In public hospitals, New South Wales had the highest number for primary palliative care hospitalisations and Victoria had the highest number for other palliative care hospitalisations. In private hospitals, Queensland had the highest number both for primary palliative care hospitalisations and other palliative care hospitalisations (with publishable data).

Variation across geographical areas

The rate of palliative care-related hospitalisations varied across remoteness categories and by public and private hospitals (Figure APC.1). In public hospitals, for primary palliative care hospitalisations people living in Inner regional and Outer regional areas had the highest rate – 21 and 24 per 10,000 population compared with 15 per 10,000 population in both Major cities and Remote and Very remote areas (combined). While for other palliative care hospitalisations, the rate of hospitalisations increased with increasing remoteness, consistent with the pattern for hospitalisations for all reasons. In private hospitals, the rate of palliative care-related hospitalisations decreased with increasing remoteness, consistent with the pattern for hospitalisations for all reasons (Table APC.4).

The rate of palliative care-related hospitalisations also varied across the states and territories – for example in public hospitals, ranging from 21 palliative care-related hospitalisations per 10,000 population in Western Australia to 46 hospitalisations per 10,000 population in Tasmania (Table APC.5).

Across the Primary Health Networks (PHN) areas, the rate of palliative care-related hospitalisations ranged from 25 hospitalisations per 10,000 population in Australian Capital Territory PHN area to 57 hospitalisations per 10,000 population in New South Wales North Coast PHN area. For hospitalisations for all reasons, people living in Northern Territory PHN area had the highest rate (7,300 per 10,000 population), while people living in New South Wales Western Sydney PHN area had the lowest rate (3,100 per 10,000 population; Figure APC.2).

Figure APC.2: Palliative care-related hospitalisations, by Primary Health Networks (PHN) areas, 2021–22

Figure 2: The interactive data visualisation shows the number and rate of palliative care-related hospitalisations across Australia's 31 Primary Health Networks in 2021–22. The number of palliative care-related hospitalisations was highest in the Central and Eastern Sydney. While the rate (per 10,000 population) of palliative care-related hospitalisations was highest in North Coast.  

Characteristics of hospital stay

Primary reason for hospitalisation

In 2021–22, among 94,800 palliative care-related hospitalisations, cancer was the most common principal diagnosis recorded for palliative care-related hospitalisations (40%) – 1 in 2 (49%) for primary palliative care hospitalisations and almost 1 in 3 (29%) for other palliative care hospitalisations (Figure APC.3).

  • Secondary site cancer (cancer of an unknown or ill-defined primary site) was the most frequently recorded cancer (9.7% and 8.8% for primary palliative care and other palliative care hospitalisations, respectively), followed by lung cancer (7.6% and 3.6% for primary palliative care and other palliative care hospitalisations, respectively).
  • Most frequently recorded principal diagnosis other than cancer was cerebrovascular disease (4.7%) and septicaemia (4.0%) for primary palliative care hospitalisations, and influenza and pneumonia (6.0%) and heart failure and complications and ill-defined heart disease (5.2%) for other palliative care hospitalisations.

Average length of stay

In 2021–22, average length of stay for palliative care-related overnight hospitalisations (hospitalisations that exclude same-day stays) was almost twice as long as all overnight hospitalisations – 10.3 days (9.3 days for primary palliative care hospitalisations and 11.5 days for other palliative care hospitalisations) compared with 5.7 days for all hospitalisations (Figure APC.3). Among palliative care-related hospitalisations:

  • Patients spent on average longer in private hospitals (12.9 days) than public hospitals (9.9 days) for overnight palliative care-related hospitalisations. In contrast, the average length of stay for overnight hospitalisations for all reasons in public hospitals (5.9 days) was slightly longer than in private hospitals (5.2 days).
  • The average length of overnight palliative care-related hospitalisations varied across the states and territories, for example in public hospitals, ranging from 7.2 days in Queensland to 12.8 days in Australian Capital Territory. 
  • In public hospitals, the average length of stay has declined for primary palliative care overnight hospitalisations – from 10.1 days to 8.7 days between 2015–16 and 2021–22. In contrast, the average length of stay remained relatively stable for primary palliative care hospitalisations in private hospitals (around 12–13 days), other palliative care (around 11–12 days in all hospitals), and hospitalisations for all reasons (5.3–5.7 days in all hospitals) over the same period.

Status at discharge

In 2021–22, almost 3 in 5 (56% or 53,000) palliative care-related hospitalisations ended with the patient dying in hospital – 67% for primary palliative care hospitalisations (69% in public hospitals and 50% in private hospitals) and 43% for other palliative care hospitalisations (41% in public hospitals and 54% in private hospitals). The next most common status at discharge was to usual residence (26%) – 22% for primary palliative care hospitalisations and 31% for other palliative care hospitalisations (Figure APC.3).

In 2021–22, almost 2 in 3 (63%) of all people who died in hospital had received palliative care during their final hospitalisation – 41% for primary palliative care and 22% for other palliative care. This proportion was higher in patients with a principal diagnosis of cancer than non-cancer diagnosis (86% and 54% respectively; Table APC.7b).

Figure APC.3: Characteristics of palliative care-related hospital stay, 2021–22

Figure 3.1: The interactive data visualisation shows the Top 10 most common primary reasons for hospitalisations and for hospitalisations ending in death of primary palliative care hospitalisations and other palliative care hospitalisations in 2021–22. Cancers had the highest number for hospitalisations and hospitalisations ending in deaths for primary palliative care and other palliative care hospitalisations. 

Figure 3.2: The interactive data visualisation shows the average length of stay for hospitalisations by reason for hospitalisations, type of hospitalisations and sector from 2015–16 to 2021–22. For palliative care-related hospitalisations, the average length of overnight hospitalisations in public hospitals declined from 10.4 days in 2015–16 to 9.9 days in 2021–22. While in private hospitals, the average length of overnight hospitalisations remained relatively stable (around 12–13 days) over the same period. 

Figure 3.3: The interactive data visualisation shows the status at discharge for hospitalisations by reason for hospitalisations and sector in 2021–22. The most common reason for discharge for palliative care-related hospitalisations in both public and private hospitals was death, followed by discharge to usual residence. Meanwhile, discharge to usual residence was the most common reason for discharge for hospitalisations for all reasons both in public hospitals and private hospitals. 

Principle funding source

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

In 2021–22 (Figure APC.4):

  • In public hospitals, public patient funding accounted for a lower proportion of palliative care-related hospitalisations (81%) than for all hospitalisations (87%). In contrast, private health insurance accounted for a higher proportion of funding for palliative care-related hospitalisations (16%) than for all hospitalisations (11%).
  • In private hospitals, private health insurance was the funding source for 75% of palliative care-related hospitalisations, lower than that for all hospitalisations (80%).

Figure APC.4: Proportion of principle funding source for palliative care-related hospitalisations, by sector, 2021–22

Figure 4.1: The interactive data visualisation shows the principal source of funds for hospitalisations by reason for hospitalisations and sector in Australia in 2021–22. In public hospitals, public patient accounted for the highest proportion of funding for palliative care-related hospitalisations. While in private hospitals, private health insurance accounted for the highest proportion of funding for palliative care-related hospitalisations.

Figure 4.2: The interactive data visualisation shows the principal source of funds for hospitalisations by reason for hospitalisations and sector across states and territories in 2021–22. Across all states and territories, public patients contributed the largest proportion of funding for palliative care-related hospitalisations in public hospitals and all hospitals, while private health insurance accounted for the highest proportion of funding in private hospitals.

Between 2015–16 and 2021–22, the number of palliative care-related hospitalisations increased more rapidly than hospitalisations for all reasons – 29% increase (from 73,600 to 94,800) compared with 10% increase (from 10.5 to 11.6 million), respectively. Among palliative care-related hospitalisations, the increase was steeper for other palliative care hospitalisations than primary palliative care hospitalisations (37% compared with 22%, respectively). These increases in palliative care and all hospitalisations were observed in both public and private hospitals (Table APC.12).

While palliative care-related hospitalisations increased by 3–5% each year between 2015–16 and 2021–22, hospitalisations for all reasons have fluctuated over this period – increased between 2–4% between 2015–16 and 2018–19, then declined by 3% in the following 12 months followed by a steep increase (by 6%) in the 12 months to 2020–21. These falls and rises likely reflect the introduction of public health measures (such as lockdowns and business/activity restrictions) in the early months of the COVID-19 pandemic (in March–August 2020) to contain the spread of the virus, and the subsequent easing of restrictions in 2021. Hospitalisations for all reasons then declined again (by 2.1%) in the 12 months to 2021–22. 

Between 2015–16 and 2021–22, the rate for palliative care-related hospitalisations also increased from 31 to 37 per 10,000 population. When adjusting for changes in the age structure of the population over this period, the changes in the hospitalisation rates were considerable smaller – increasing from 26 to 28 per 10,000 population between 2015–16 and 2021–22 (Figure APC.5). This suggests that the ageing of Australia’s population is contributing to the growth in palliative care-related hospitalisations.

Figure APC.5: Trends in palliative care-related hospitalisations, by sector, 2015–16 to 2021–22

Figure 5: The interactive data visualisation shows the trends of hospitalisations by reason for hospitalisations and sector from 2015–16 to 2021–22. The number, rate (per 10,000 population) and age-standardised rate (per 10,000 population) of palliative care-related hospitalisations in public hospitals and all hospitals increased between 2015–16 and 2021–22, while it remained relatively stable for private hospitals over the same period.

Expenditure on palliative care in public hospitals

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

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

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