AMA: Hospitals at Worst in 20 Years

The Australian Medical Association (AMA) is sounding the alarm about the parlous state of hospitals. This follows release of 2023 data by the Australian Institute of Health and Welfare (AIHW), the federal body responsible for health-related data.

On the AIHW data on response and wait-time, hospitals are at their worst state in the 20 years of detailed record-keeping on the subject.

AMA President Professor Steve Robson describes a lack of capacity in hospitals that has led to unacceptable emergency department wait-times and people waiting years for essential surgery, with 850,000 people currently on the surgery wait-list.

“Australia’s public hospital performance is at its worst since the AMA started tracking the data 20 years ago,” Professor Robson said. “Public hospitals are inadequately funded and resourced.”

Just 44% of patients presenting to an emergency room are either admitted to hospital or discharged within four hours. In Tasmania, the proportion is 22% and in New South Wales it’s 25%.

For reference, in the Netherlands, a country about as wealthy as Australia, 78% of emergency department patients are seen within four hours. A Dutch medical association blamed the excess wait-times (i.e. for the remaining 22% of patients) for an additional 1,000 deaths annually.

A consequence of overloaded emergency departments is “ambulance ramping,” where paramedics have no-one to hand emergency patients to. The states have a goal of unloading 85-90% of ambulance patients within 30min of their arrival at hospital, and none are achieving it.

Why is it happening? According to the AIHW, “Over time, ED activity has grown faster than population growth both in terms of the number of presentations to EDs and the amount of hours each person spends in ED.” In Melbourne, for example, there was a 55% increase in emergency department presentations between 1999 and 2009, with only a 19% increase in population.

It is not entirely clear how COVID is impacting population health and interacting with other health conditions. But the pre-COVID (2019) normal of 310 emergency room presentations per 1,000 population has now risen to 334 per 1,000. NSW Ambulance reported a record number of emergency calls in 2023.

NZ experts recently noted that COVID remains a leading cause of serious illness and death. Moreover, long COVID – the persistence of COVID symptoms – was found in a study of 200,000 participants to be around 6.5% after 6 and 12 months, but rising to 10% after 18 months. This suggests the virus’s effect on public health are widespread, persistent and not yet well understood.

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