Access and timeliness
Healthcare services for patients when and
where they need them
Ensuring people receive health services when
For most types of elective (or planned) surgery,
and where they need them is a central element
there is little evidence that moderate waits harm
of quality healthcare.
patient health.
Available evidence suggests access and
This chapter covers:
timeliness of appropriate healthcare are
important because:
• Patient assessments of how easily they are able to access healthcare
• Availability of good primary care
delivers better access to care and
achieves better health outcomes,
often at a lower cost
• Hospital information collected on
waiting times for elective surgery
and length of waits for specialist
appointments
• Waiting times can influence the way
patients seek care, such as visiting
a hospital emergency department
• Barriers to access, such as lack of
personal or public transport, and costs.
rather than a GP
Although we examine separate data for primary,
• If healthcare services and
specialty and surgical care, it is important to
diagnostic test results are not
available or not delivered in a timely
way, patients can experience
emotional distress, physical harm,
and higher treatment costs
note that patients experience a ‘healthcare
journey’ when they are ill and need care, which
may include access to different healthcare
professionals and services.
• Long-term disability or risk of death
from acute conditions such as
stroke and heart attack are greatly
influenced by timeliness of treatment
• Prolonged waiting for certain
procedures such as hip replacement
and spinal surgery may reduce
patients’ quality of life, their
productivity at work, and the likelihood
of achieving good health outcomes.
27
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
How does NSW compare
internationally?
What we learnt about NSW
Higher ranking
Middle ranking
Lower ranking

Access and
medical attention they were able to get an appointment to see a
doctor or nurse on the same day (43%) or the next day (20%)
Less than half of adults who needed out of hours care said it
was either very easy (14%) or somewhat easy (23%) to get

medical care without going to an emergency department
Around eight in 10 adults (82%) who visited an emergency
department in the past two years report waiting less than four

hours the last time they went
Around three in 10 adults (33%) report using emergency
departments for conditions that could be treated in primary care
Over one in 10 adults (14%) who received elective surgery in
the previous two years report waiting more than six months


Over three in 10 adults (36%) who were referred to a specialist
in the previous two years report waiting more than one month

for an appointment
Almost one in 10 adults (9%) adults do not visit the doctor
because of travel difficulties
Around one in seven adults (14%) had a medical problem in the
previous year but did not see a doctor because of cost.
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au


28
timeliness
Six in 10 adults say that the last time they were sick or needed
Access and timeliness: primary care
Access to primary care is difficult after-hours
In 2010, 92% of NSW adults reported that
either somewhat (24%) or very difficult (39%) to
they had a regular place providing most of their
access medical care out of hours was higher
medical care.*
than in almost all other countries (Figure 3.2).
Six in 10 adults said that the last time they were
The ABS Patient Experience Survey conducted
sick or needed medical attention they were able
in 2009 asked about waiting times for an urgent
to get an appointment to see a doctor or nurse
GP appointment, and more than six in 10 people
on the same day (43%) or the next day (20%)
aged 15 years or over in NSW (64%) were able to
(Figure 3.1).
obtain an appointment within four hours. Almost
nine out of every 10 (88%) were seen on the
On evenings, weekends or holidays though,
same or next day (Figure 3.3).
less than half of NSW adults who needed out of
hours care said it was either very easy (14%) or
Yet the same survey found that almost one in five
somewhat easy (23%) to access medical care
people aged 15 or over (18%) considered the
without going to an emergency department.
wait to see a GP on their last visit unacceptable.◊
The percentage of NSW adults who said it was
Figure 3.1: Survey 2010: Last time you were sick or needed medical attention,
how quickly could you get an appointment to see a doctor or nurse?
Please do not include a visit to the hospital ED*
On the same day
The next day
2 - 7 days
Never able to get an appointment
Not sure / Decline to answer
Switzerland
High performance
> 8 days
86
New Zealand
5
49
Netherlands
45
New South Wales
43
29
42
42
22
Rest of Australia
41
25
Norway
31
United Kingdom
30
Canada
0
10
20
30
10
12
35
15
2
1
14
16
1
28
28
40
1 3
7
29
24
38
28
3
8
26
11
50
70
80
1
5
7
21
21
60
1
13
24
13
5
10
24
18
35
3
26
18
37
Sweden
3 1
24
20
France
United States
19
24
Germany
5 12
3
90
6
100
% of adults
29
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
Figure 3.2: Survey 2010: How easy or difficult is it to get medical care in the evenings, on
weekends, or holidays without going to the hospital ED?*
Very easy
Somewhat easy
Somewhat difficult
Very difficult
Not sure / Decline to answer
35
19
Netherlands
42
Rest of Australia
17
United Kingdom
16
Switzerland
15
New South Wales
14
23
United States
14
22
Norway
9
Germany
9
France
6
Sweden
5
9
30
24
10
1
5
25
15
27
10
36
33
3
44
11
42
30
50
3
21
28
40
5
32
37
30
1
39
28
25
20
1
29
39
10
8
30
46
22
2
5
26
31
0
16
25
26
13
Canada
21
60
70
15
80
100
90
% of adults who required care in evenings, weekends or holidays
Figure 3.3: Survey 2009: Waiting times for urgent GP appointment, NSW and rest of Australia◊
High performance
within 4 hours
More than 4 hours but same day
New South Wales
Next day
64
Rest of Australia
13
58
0
10
20
30
16
40
50
60
2 or more days
11
13
15
70
80
11
90
100
% of people aged 15+ years who saw a GP for urgent medical care
(*) 2010 Commonwealth Fund International Health Policy Survey (Notes: Percentages may not add up to 100 due to
rounding; Figure 3.2 excludes those who never needed out of hours care).
(◊) ABS Patient Experiences Survey, 2009 (Note: Percentages may not add up to 100 due to rounding).
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
30
timeliness
26
Access and
High performance
New Zealand
Access and timeliness: emergency departments
Around eight in 10 people wait less than four hours
in NSW emergency departments
According to the ABS Patient Experience
There has been some concern across Australia
Survey in 2009, more than one in ten (13%)
that difficulties accessing primary care may have a
people in NSW aged 15 years or over visited
knock-on effect on ED workloads and contribute
the ED at least once in the previous year. About
to long treatment delays. This is an important
3% made multiple visits. Australia-wide figures
consideration, since there are over two million
were 13% and 4% respectively.
ED visits annually in NSW.2
In 2010, when asked to recall the time they
More than three in 10 NSW adults (33%) who
waited at their last ED visit, 82% of NSW
have a regular GP or general practice and used
adults reported waiting less than four hours
an ED in the previous two years, reported in
– a percentage similar to that reported in other
2010 that their most recent ED visit was for a
countries (Figure 3.4).
condition they thought could have been treated
1
by doctors or staff at their regular general
More detailed data on timeliness of ED care
practice had they been available (Figure 3.5).
across NSW are available in reports released
on a quarterly basis from the Bureau of Health
NSW performance on this measure sits in the
Information (www.bhi.nsw.gov.au).
middle of other countries surveyed.
2
Figure 3.4: Survey 2010: The last time you went to the hospital ED, how long did you wait
before being treated?*
< 30 min
30 min < 1 hour
1 hour < 4 hours
Never treated / left without being treated
High performance
Not sure / Decline to answer
52
Netherlands
25
46
New Zealand
Switzerland
> 4 hours
20
13
44
29
31
34
United States
34
19
34
Norway
33
17
35
New South Wales
33
18
Germany
33
32
Sweden
12
Canada
10
13
31
20
1
3 1
19
49
40
50
29
60
70
1
11
4 2
36
30
16
14
32
12
1
2 3
36
19
1
10
36
17
20
0
16
26
26
5 1
37
17
29
United Kingdom
11
20
France
Rest of Australia
3
80
21
90
100
% of adults who used ED in previous two years
31
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
Figure 3.5: Survey 2010: The last time you went to the hospital ED, was it for a condition that you
thought could have been treated by doctors or staff at the place where you usually get
medical care if they had been available?*
Did not use ED for primary care
Used ED for primary care
78
73
New Zealand
25
69
New South Wales
66
Rest of Australia
65
Norway
33
Netherlands
56
55
2
31
58
United Kingdom
1
33
63
Sweden
2
31
6
35
7
37
6
37
8
Switzerland
52
44
3
Canada
51
45
4
United States
49
0
10
20
49
30
40
50
60
70
2
80
90
100
% of adults who have regular GP / GP practice and have used ED in previous two years
(*) 2010 Commonwealth Fund International Health Policy Survey (Note: Percentages may not add up to 100 due to rounding).
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
32
timeliness
Germany
22
Access and
France
High performance
Not sure / Decline to answer
Access and timeliness: elective surgery
Many NSW adults have long waits for elective surgery in
public and private hospitals
Elective or 'planned' surgery is defined as surgery
their surgeon – a higher percentage than any
that a doctor or other health professional believes
other state and Australia as a whole (86%).3
to be clinically necessary, but which can be
delayed for at least 24 hours. These operations
Despite this, in 2009-10 NSW had longer median
are booked in advance, following medical
wait times for surgery (44 days) than all other
assessment of the patient.
states except the ACT (73 days) and Northern
Territory (46 days) (Figure 3.7). The median wait
About eight in 10 NSW adults (85%) receiving
refers to the number of days that the ‘middle’
elective surgery in the previous two years,
patient waited i.e. half of all patients had a shorter
reported in 2010 that they waited less than
wait and half of all patients had a longer wait.
six months. More NSW adults wait longer than six
months for elective surgery (14%) than in many of
Median waits for specific procedures reveal
the other countries surveyed (Figure 3.6).
some differences between NSW and Australia
as a whole (Figure 3.8). More detailed and recent
In 2008-09, interstate data show that nine in 10
data on timeliness of elective surgery across NSW
NSW surgery patients (91%) received elective
public hospitals are available from the Bureau of
surgery within the timeframe recommended by
Health Information (www.bhi.nsw.gov.au).
Figure 3.6: Survey 2010: After you were advised you needed surgery, how long did you have
to wait for the non-emergency or elective surgery (public and private hospitals)?*
< 1 month (inc no wait)
1 to < 3 months
3 months to 6 months
> 6 months
Not sure / Decline to answer
78
High performance
Germany
18
68
United States
United Kingdom
59
Netherlands
59
18
14
Switzerland
55
New Zealand
54
New South Wales
46
France
46
Norway
35
Sweden
34
0
10
6
12
29
41
15
30
40
1
12
2
9
26
60
70
2
11
22
50
3
14
30
24
11
14
13
11
80
2
1
14
29
26
5
12
8
25
20
2
15
23
44
Canada
8
33
56
Rest of Australia
4
3
8
90
100
% of adults who needed non-emergency surgery in previous two years
33
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
Figure 3.7:
Median waits for all elective surgery, public hospitals, 2000-01 to 2009-10 ∑
80
Australian Capital Territory
70
60
Days
50
Northern Territory
New South Wales
Tasmania
South Australia
Victoria
Western Australia
40
30
Queensland
20
2000-01 to 2009-10
0
9
-1
09
20
20
08
-0
8
20
07
-0
7
06
20
20
05
-0
6
Victoria
New
South
Wales
Western
Australia
Northern
Territory
Australian
Capital
Territory
+5
+8
+16
+12
+21
+29
+9%
+41%
+3%
+55%
+72%
+43%
Tasmania
South
Australia
Queens
-land
-1
+2
+28%
+24%
Change in median waits (days)
% change in elective surgery admissions
-0
5
04
20
20
02
03
-0
4
-0
3
-0
2
20
-0
01
20
20
00
-0
1
0
Figure 3.8: Median waits, selected surgical procedures, public hospitals, NSW and Australia 2009-10 ∑
New South Wales
Australia
350
301
300
Days
250
220
211
200
150
116
86
100
50
180
167
44
91
36
0
Number of
procedures 2009-10
Tonsillectomy
Tonsillectomy
Total hip
hip
Total
replacement
replacement
19,070
4,946
3,023
5,217
52,091
16,833
8,572
12,513
Total
Total
Cataract
Cataract
extraction
extraction
NSW
198,503
Australia
609,505
Total
Totalknee
knee
replacement
replacement
(*) 2010 Commonwealth Fund International Health Policy Survey (Note: Percentages may not add up to 100 due to rounding).
(∑) AIHW, Australian Hospital Statistics, citing National Elective Surgery Waiting Times Data Collection, 2000-10.
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
34
timeliness
Access and
10
Access and timeliness: barriers to healthcare
Cost is an important barrier to care in NSW
The 2009 ABS Patient Experience Survey1 found
More than one in 10 NSW adults reported
that around one in 20 people in NSW (5%) had
that concerns about costs created a barrier
needed healthcare in the previous year on at least
to accessing healthcare – discouraging them
one occasion but were unable to access it.
from seeing a doctor (14%), from having a
recommended medical test, treatment or
Barriers to accessing healthcare can be caused by
follow-up (15%), or from filling or fully following
a range of factors, including difficulties travelling,
a prescription (13%).
lack of health insurance coverage, the availability
of services, limited health literacy and costs.
Generally, adults from NSW were more likely to
report cost concerns as a barrier to healthcare
Access to healthcare can be a problem in
than those from any other surveyed country
countries like Australia where distance can pose
except the United States (Figure 3.10).
significant travel difficulties.
In 2010, almost one in 10 (9%) adults in NSW
said there was a time in the previous year when
they did not visit the doctor because of difficulties
travelling. This was among the highest rates seen
internationally but not dissimilar to other large
countries (Figure 3.9).
Figure 3.9: Survey 2010: During the past 12 months, was there a time when you did not visit
a doctor because of difficulties travelling?*
No
Yes
Not applicable
High performance
Switzerland
2 3
95
Netherlands
92
New Zealand
3
6
95
Sweden
4
92
Germany
4
94
France
3
4 2
91
4
4
United Kingdom
94
5 1
Norway
93
6
Canada
93
6
1
United States
90
Rest of Australia
89
9
2
New South Wales
89
9
1
0
10
20
30
40
9
50
60
70
80
90
1
100
% of adults
35
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
Figure 3.10:
Survey 2010: During the past 12 months, was there a time when you had a medical
problem but (a) did not visit a doctor because of cost; (b) skipped a medical test,
treatment or follow-up that was recommended by a doctor because of cost; (c) did not
fill a prescription for medicine, or you skipped doses of your medicine because of cost?*
New South Wales
Rest of Australia
Other countries
Netherlands 2
United Kingdom 2
Canada 4
5
Sweden
Norway
6
France
6
Switzerland
6
New Zealand
9
Rest of Australia
12
14
Germany
United States
16
22
High performance
(b) During the past 12 months, was there a time when you had a medical problem but:
skipped a medical test, treatment or follow-up that was recommended by a doctor because of cost?
Netherlands
United Kingdom
Sweden
Switzerland
Canada
Norway
France
New Zealand
Germany
Rest of Australia
3
3
4
4
5
5
6
8
10
13
% Answering yes
15
New South Wales
United States
22
High performance
(c) During the past 12 months, was there a time when you had a medical problem but:
did not fill a prescription for medicine, or you skipped doses of your medicine because of cost?
United Kingdom 2
Netherlands 3
Switzerland 4
Norway
6
Germany
6
France
7
New Zealand
7
Sweden
7
Canada
10
Rest of Australia
12
New South Wales
% Answering yes
13
United States
21
0
20
40
60
80
100
% of adults
(*) 2010 Commonwealth Fund International Health Policy Survey (Note: Percentages may not add up to 100 due to rounding).
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
www.bhi.nsw.gov.au
36
timeliness
New South Wales
% Answering yes
Access and
High performance
(a) During the past 12 months, was there a time when you had a medical problem but:
did not visit a doctor because of cost?
Access and timeliness: specialist care
Many patients have considerable waits for specialist appointments
Patients visit specialists for an array of different
The 2009 ABS Patient Experience Survey1 found
reasons such as for diagnosis, treatment and
that one in five people (19.7%) aged 15 years or
monitoring of significant illnesses and injuries;
over in NSW said they had an unacceptably long
as well as dedicated services related to the health
wait for a specialist appointment. This is similar to
of children, pregnant women and older adults.
the 20.5% reported for the rest of Australia.
In 2010, among NSW adults who reported they
were referred to a specialist in the previous two
years, (64%) waited less than one month for an
appointment. More than a third (36%) waited
one month or longer (Figure 3.11).
Figure 3.11:
Survey 2010: After you were advised to see or decided to see a specialist doctor or
consultant, how long did you have to wait for an appointment?*
< 1 month (inc. No wait time)
1 months to < 2 months
2 months or longer
High performance
Not sure / Decline to answer
Germany
90
5
4 1
Switzerland
89
7
2 2
United States
87
United Kingdom
4
79
Netherlands
9
77
New Zealand
France
64
New South Wales
64
Sweden
Canada
13
10
20
17
22
18
11
55
0
18
12
57
40
50
60
2
18
22
13
30
10
29
70
1
14
12
70
Norway
9
13
70
4
12
13
73
Rest of Australia
5
80
3
90
100
% of adults who saw or needed to see specialist in previous two years
(*) 2010 Commonwealth Fund International Health Policy Survey (Note: Percentages may not add up to 100 due to rounding).
37
HE ALTHCARE IN FOCUS: Access and timeliness
December 2010
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December 2010
www.bhi.nsw.gov.au
38
timeliness
Access and
HE ALTHCARE IN FOCUS: Access and timeliness