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FEATURE 2016 – A turning point? On the eve of the 2017 funding cliff, the Federal Government has just three months to deliver a Budget that will thwart an imminent crisis for public hospitals. The 2016 AMA Public Hospital Report Card might be the most important snapshot of Australia’s healthcare system the organisation has released to date – given that the Federal Government has just a few months left to fix the funding problems that threaten to cripple the healthcare system prior to the 2017 funding cliff. “The States and Territories are facing a public hospital funding ‘black hole’ from 2017 when growth in Federal funding slows to a trickle,” said AMA President, Professor Brian Owler. “From July 2017, the Commonwealth will strictly limit its contribution to public hospital costs.” Growth in Commonwealth funding will be restricted to indexation using the Consumer Price Index (CPI) and population growth only. Treasury advised the Senate Economics Committee that this change will reduce Commonwealth public hospital funding by $57 billion over the period 2017-18 to 2024-25. With 2016 shaping up to be an Election year, the AMA is hoping the data released in its report will put scrutiny on the Federal Government. The big turning point, if there is to be one, is the May Budget, which the AMA is hoping will be a positive Health Budget. “This is the Budget where it has to be done,” Prof Owler said. “This is what makes this report so timely and so important.” In the 2015-16 Budget, Commonwealth funding for public hospitals was reduced by $423 million for three years to 2017- 18. A further $31 million was cut in the December 2015 MYEFO Budget update. “Public hospital funding is about to become the biggest challenge facing States and Territory finances – and the dire consequences are already starting to show.” The AMA Public Hospital Report Card, released in late January, revealed the performance of public hospitals is virtually stagnant, and even declining in key areas. According to Prof Owler, the disappointing results are a direct consequence of reduced growth in the Commonwealth’s funding of public hospitals. The report shows bed number ratios have deteriorated; waiting times are largely static, with only very minor improvement; Emergency Department waiting times have worsened; the percentage of ED patients treated in four hours has not changed, and is well below target; and elective surgery waiting times and treatment targets are largely unchanged. “This is the Budget where it has to be done,” Prof Owler said. “This is what makes this report so timely and so important.” KEY FINDINGS Hospital bed to population numbers have remained constant over recent years, while there has been increasing demand for hospital services. Nationally, only 68% of emergency department patients classified as urgent were seen within the recommended 30 minutes. In 2014-15, no State or Territory met the interim (2014) or final (2015) National Emergency Access Target of patients being treated within four hours. Performance in Victoria and Western Australia was below their 2013 targets, and performance in South Australia, Tasmania, the Northern Territory and the ACT was below their 2012 targets, with the Northern Territory performance in 2014-15 failing to meet their baseline for this target. 10 I THE NSW DOCTOR I MARCH/APRIL 2016
57 Elective Surgery – Waiting times Median waiting time for elective surgery (days) - NSW “Public hospital performance has not improved overall against the performance benchmarks set by all Governments.” In NSW, the report indicated the State was falling short in three of the five key performance benchmarks. Elective surgery waiting times have increased to more than 52 days. While the figures found that more than 75% of urgent patients were seen within the recommended four-hour waiting time – unchanged from last year – it is still short of the 90% target. Longer wait times in emergency departments and for elective surgery has far reaching affects on patients’ health, Prof Owler said. “When people wait longer in emergency departments, it’s not an inconvenience. We know that overcrowding and long wait times in emergency departments are associated with increased morbidity and even mortality. That is, people actually have more complications if they’re all stuffed into an emergency department and not receiving the appropriate care in the appropriate part of the hospital. So, this is more than just an inconvenience, and obviously people waiting on elective surgery lists – it might be for something like a hip or knee replacement, it might be for cancer surgery. But when people wait long periods, obviously their condition can deteriorate, and if people aren’t able to exercise or walk, they often put on weight, they get cardiovascular disease, diabetes, and so they end up in the much worse shape by the time they actually do get their procedure.” dr. 52 47 42 37 32 27 100% 90% 80% 70% 60% 50% 2001/ 2002 2002/ 2003 2003/ 2004 2004/ 2005 2005/ 2006 2006/ 2007 2007/ 2008 2008/ 2009 2009/ 2010 2010/ 2011 2011/ 2012 Sources: AIHW elective surgery data cubes (2001-02 to 2006-07); AIHW Australian Hospitals Statistics: elective surgery waiting times (2007-08 to 2014-15) National Emergency Access Target (NEAT) Percentage of emergency department visits completed in four hours or less - NSW Baseline 40% 2011/12 2012-13 2013-14 2014-15 Source: Australian Hospitals Statistics 2011-12 to 2014-15: emergency department care (AIHW) State and Territory Performance - Summary State/ Territory Improvement in Emergency Department waiting time - urgent (category 3) 2014-15 Met National Emergency Access Target (NEAT) 2014+ Improvement in Elective Surgery waiting time 2014-15 Met National Elective Surgery Target (NEST)+* 2014 Improvement in Elective Surgery Category 2 admission in 90 days 2012/ 2013 Target 2013/ 2014 2014/ 2015 MYEFO 2015- 16 increased Commonwealth funding for 2015-16 over Budget 2015-16 NSW ✘ ✘ ✘ ✔ ✔ ✘ VIC ✘ ✘ ✔ ✘ ✔ ✔ QLD ✘ ✘ ✔ ✘ ✔ ✔ WA ✘ ✘ ✘ ✘ ✘ ✔ SA ✘ ✘ ✘ ✘ ✘ ✘ TAS ✘ ✘ ✘ ✘ ✘ ✘ ACT ✘ ✘ ✔ ✘ ✘ ✘ NT ✔ ✘ ✔ ✘ ✘ ✘ + Targets are set on a calendar year basis; performance as reported by AIHW. AIHW reported elective surgery Category 2 performance for financial year 2013-14 but data for the period 2010-11 to 2011-12, and January to June 2013 has not been published. Elective surgery Category 2 year on year performance is graphed for each State and Territory below, excluding these periods. *Treating patients within clinically recommended time – Category 2 (within 90 days) amansw.com.au I 11
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