Which state has the worst hospitals?
Let’s get one thing straight. No state actually has good hospitals.
The whole system has been too neglected and too poorly resourced for too long. It has become one of the nation's most potent political issues, with the government of South Australia changing hands largely on this single issue.| Ambulance ramping in Adelaide |
People in every jurisdiction complain – with justice, usually – about the inability of their public hospitals to do the job they’re meant to. But some are worse than others.
There are several measures we can use to work this out. (Because delivery of healthcare in the Northern Territory is so different from everywhere else, I’m leaving them out of these calculations.)
COST EFFECTIVENESS
When funding is so inadequate, it becomes even more important to use what we have as wisely and efficiently as possible. The Independent Hospital Pricing Authority keeps track of how much things cost in hospitals around the country. Two areas – admitted patient care, and emergency – account for almost all the work in a public hospital.
For its “admitted acute” category, the IHPA calculates how much it costs in each state to treat a patient. But because it’s more expensive to treat someone needing, say, a cardiac artery bypass than someone needing a cataract removed, it’s all rendered down into a single figure – the cost per weighted separation. A separation, by the way, is “a completed episode of inpatient care”.
These figures also show how well (or badly) placed each state was to deal with the disruptions of the imminent pandemic.
As hospitals become more and more overcrowded, staff work less efficiently and costs escalate. In this chart showing the most cost-efficient (New South Wales), the least (Tasmania) and the average, we can see where that trend has hit the most.
Over the five years, the average cost of treating an inpatient in New South Wales rose by 0.9%, in Australia as a whole by 2.1% and in Tasmania by 22.8%:
|
NSW |
VIC |
QLD |
SA |
WA |
TAS |
ACT |
AUST |
|
0.91% |
7.90% |
2.04% |
-1.69% |
-5.11% |
22.84% |
-5.57% |
2.12% |
Costs in emergency departments increased everywhere over the five years to 2018-19 except in the ACT, which wound back some of its earlier inefficiency. Again, though, Tasmania had by far the worst result.
In emergency care, Victoria was the most efficient and, again, Tasmania the least.
|
NSW |
VIC |
QLD |
SA |
WA |
TAS |
ACT |
AUST |
|
18.2% |
23.4% |
11.6% |
26.3% |
20.5% |
58.1% |
-0.2% |
18.8% |
Governments -- and their Treasury officials -- squeeze budgets because they think it saves money. It does the opposite.
The Upshot: best to worst in cost efficiency
1) New South Wales
2) Victoria
3) Queensland
4) South Australia
5) Western Australia
6) Australian Capital Territory
7) Tasmania
PRODUCTIVITY
The optimal use of staff is a key element in running a hospital so it can deliver the best care to the most people. Poorly-run hospitals make poor use of their available staff.
Overcrowding makes it worse. When hospitals are under severe pressure, staff work less efficiently because they spend time juggling the system that they otherwise would spend on treating patients.
The best measure of the amount of work accomplished in a hospital is the number of patient days delivered in a year for each clinical member of staff – that is, doctors, nurses and allied health professionals. As we can see in this chart, staff productivity varies greatly across the country.
The Upshot: best to worst in productivity
1) South Australia
2) Australian Capital Territory
3) New South Wales
4) Victoria
5) Tasmania
6) Queensland
7) Western Australia
BED BLOCK
Bed (or access) block is when a patient needing admission to a specialist ward is kept in the emergency department for too long. In Australia, “too long” is defined as anything over eight hours. When that happens, someone’s existing risk of dying increases by around 30%: if you’ve got a 20% chance of dying, bed block will bump that up to 26%.
Bed block is a big deal. The only good measure is the time waited by a patient at the 90th percentile: that’s the time within which 90% of patients have been admitted and 10% are still waiting.
On a state-by-state basis, here are the figures for 2020-21 in hours.minutes:
|
Time in emergency at 90th percentile for patients needing admission |
|||||||
|
NSW |
VIC |
QLD |
SA |
WA |
TAS |
ACT |
AUST |
|
15.25 |
12.46 |
10.21 |
12.46 |
10.59 |
22.33 |
12.18 |
12.57 |
All states are running dangerous levels of bed block, causing thousands of avoidable deaths every year. Again, none approach Tasmania’s level.
Trends are also important, though: is a particular state getting worse faster than the others? New South Wales has that dubious honour. Bed block in its public hospitals was 34% worse in 2020-21 than it had been five years earlier, though the ACT was almost as bad. But all these results are appalling, and all indicate a major toll of avoidable death and distress on the individuals behind these bald statistics.
|
Increase in bed block over five years, 2016-17 to 2020-21 |
|||||||
|
NSW |
VIC |
QLD |
SA |
WA |
TAS |
ACT |
AUST |
|
34.2% |
20.2% |
11.6% |
12.8% |
10.6% |
26.95% |
33.2% |
20.4% |
|
Australia’s ten worst bed block hospitals |
||
|
Hospital |
State |
Hours.min |
|
Launceston General Hospital |
TAS |
27.52 |
|
Mersey Regional Hospital |
TAS |
24.46 |
|
Nepean Hospital |
NSW |
22.26 |
|
Wollongong Hospital |
NSW |
22.13 |
|
Shoalhaven Hospital |
NSW |
22.11 |
|
Orange Health Service |
NSW |
22.11 |
|
Coffs Harbour Hospital |
NSW |
20.52 |
|
Mildura Base Hospital |
VIC |
20.42 |
|
Port Macquarie Base Hospital |
NSW |
20.30 |
|
Blacktown Hospital |
NSW |
19.46 |
Of the ten safest hospitals for bed block, none are in Tasmania or the ACT and only one is in NSW.
|
Australia’s ten best bed block hospitals |
||
|
Hospital |
State |
Hours.min |
|
Whyalla Hospital |
SA |
5.12 |
|
Royal Women's Hospital |
VIC |
5.41 |
|
Robina Hospital |
QLD |
6.32 |
|
Sydney Hospital/Eye Hospital |
NSW |
6.38 |
|
Women's and Children's Hospital |
SA |
6.45 |
|
King Edward Memorial Hospital |
WA |
6.48 |
|
Mater Adult Hospital |
QLD |
6.55 |
|
Sandringham Hospital |
VIC |
7.12 |
|
Port Augusta Hospital |
SA |
7.17 |
|
Casey Hospital |
VIC |
7.25 |
Interestingly, there is a strong correlation between public hospitals with high levels of bed block (indicating severe overcrowding and under-resourcing) and being located in a lower-income area. Conversely, the safest (least crowded and better resourced) public hospitals tend to be in wealthier areas. The exception to this is South Australia.
But overall, only 14 of Australia’s 142 large and medium sized public hospitals can claim to be reasonably safe on the bed block measure. The other 90.1% can only be regarded as unsafe in varying degrees.
The Upshot: best to worst in bed block
1) Queensland
2) Western Australia
3) South Australia
4) Victoria
5) Australian Capital Territory
6) New South Wales
7) Tasmania
ELECTIVE SURGERY
Because of the pandemic there have been widespread cancellations of elective surgery to make room for medical patients with Covid-19 and its complications. But because the cancellations were spread unevenly through the country (Victoria a lot, WA and Tasmania very little) a slightly earlier period provides a more accurate comparison of underlying capacity. And because elective surgery waiting lists are often manipulated by governments running short-term (and ineffective) blitzes, I’ve used a five-year average (2015-16 to 2019-20) to iron out these distortions.
This chart gives a good indication of the relative capacity of each state system to deal with elective surgery demand in a normal year. The waiting times shown here represent the point at which 90% of patients on the list have been treated but 10% are still waiting. The range in performance is glaring.
Even this does not tell us how long some people have to spend on the waiting lists before receiving treatment. The percentage of people waiting longer than a year gives us, though, some idea. Again, the figures are a five-year average from 2015-16 to 2019-20.
Here, the variation between states is even more striking.
The Upshot: best to worst in elective surgery
1) Victoria
2) Western Australia
3) Queensland
4) South Australia
5) Australian Capital Territory
6) New South Wales
7) Tasmania
Overall, I’ve allocated equal points for each of the main categories – cost effectiveness, productivity, bed block and elective surgery. The top state in each gets seven points and the bottom state gets one.
The Upshot: best to worst in overall rankings
1) Victoria (21 points)
2) South Australia (20 points)
3) Queensland (19 points)
=4) New South Wales (16 points)
=4) Western Australia (16 points)
6) Australian Capital Territory (14 points)
7) Tasmania (6 points).
Maximum possible score: 28
Minimum possible score: 4