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Indicator: HS-14 Indicators of health and wellbeing

Data

The following three datasets are identified to populate this indicator.

• Number of employed medical practitioners relative to population
• Hospitals by separation from population
• Mortality rates by causes of mortality

Employed medical practitioners by region of main job
Australia – 1997-2002
(Full-time Equivalent (FTE) rate per 100 000 population)

	Major cities		Inner regional areas		Outer regional areas		Remote areas		Very remote areas
	1997	2002	1997	2002	1997	2002	1997	2002	1997	2002
Clinicians	289	288	167	169	141	138	121	130	106	134
Primary care	112	105	94	90	88	80	86	86	67	93
Hospital non-specialists	29	29	12	14	13	15	18	19	25	28
Specialist	110	114	53	55	34	35	14	19	9	10
Specialist-in-training	37	40	7	10	6	8	3	6	5	3
Non-clinicians	26	24	7	7	7	8	8	10	6	7
Total	315	312	174	176	147	146	129	140	112	141

Source: Australian Institute of Health and Welfare 2004, Medical labour force 2002, Australian Institute of Health and Welfare, viewed 15 Dec 2005, http://www.aihw.gov.au/publications/index.cfm/title/10071, pp.10-11.

• Medical Labour force, 2002 (PDF - 310 KB) 

Hospital Separation rate by remoteness areas – Per 1000 population¹
Australia – 2002-03

	Major cities	Inner Regional	Outer Regional	Remote	Very Remote	Total²
Public	192.1	210.9	257.6	311.6	429.4	206.5
Private	139.9	118.0	89.6	69.7	44.8	128.6
All Separations	332.0	328.9	347.2	381.3	474.1	335.1

¹ - Rate per 1 000 population was directly standardised to the Australian population at 30 June 2001.
² - includes Other territories and excluded non-Australian residents and Unknown state of residence.

Source: Australian Institute of Health and Welfare 2004, Australian hospital statistics 2000-03, Australian Institute of Health and Welfare, viewed 15 Dec 2005, http://www.aihw.gov.au/publications/index.cfm/title/10130, p.156.

Mental health-related separations with specialised psychiatric care
(Age standardised rate¹ by area of usual residence of patient)
Australia – 2001-02

	Major cities	Inner regional	Outer regional	Remote	Very remote	Total2
Same day separations per 1000 population	0.5	0.5	0.3	0.0	0.1	0.4
Overnight separations per 1000 population	5.3	5.2	4.1	2.7	2.5	5.3
All separations	5.8	5.7	4.4	2.8	2.7	5.7

¹ – rates indirectly standardised using the estimate resident population as at 30 June 2001.
² – includes separations for which the state of usual residence was Other territories or not reported.

Source: Australian Institute of Health and Welfare (AIHW) 2004, Mental health services in Australia 2001-02, Australian Institute of Health and Welfare (AIHW), viewed 15 Dec 2005, http://www.aihw.gov.au/publications/index.cfm/title/10004, p. 102.

Standardised Mortality Ratios (SMRs) – All-causes
Australia – 1992-1999

	Major cities	Inner regional	Outer regional	Remote	Very remote
Male
1992	1.19	1.22	1.30	1.33	2.12
1993	1.13	1.16	1.27	1.40	1.93
1994	1.14	1.19	1.27	1.34	1.75
1995	1.09	1.11	1.21	1.25	1.70
1996	1.08	1.12	1.22	1.22	1.61
1997	1.04	1.11	1.16	1.18	1.48
1998	1.00	1.06	1.18	1.18	1.60
1999	0.97	1.04	1.13	1.13	1.40
Female
1992	1.14	1.18	1.24	1.30	2.14
1993	1.08	1.11	1.17	1.23	2.11
1994	1.10	1.13	1.17	1.19	1.81
1995	1.06	1.09	1.13	1.17	1.80
1996	1.06	1.08	1.12	1.14	1.62
1997	1.04	1.08	1.11	1.12	1.62
1998	0.99	1.02	1.05	1.10	1.52
1999	0.97	1.03	1.06	1.05	1.41

Reported statistics are ratios of observed to expected deaths. Expected deaths were based on age-specific death rates in Major cities in the period 1997-1999 and the estimated population in each area in each year.
SMRs for males and females cannot be compared (SMRs for males are calculated using MC rates for non-Indigenous males; those for females are based on MC rates for non-Indigenous females.

Source: Australian Institute of Health and Welfare 2003, Rural, regional and remote health: a study on mortality.

Leading causes of 'excess' deaths in areas outside Major Cities
Australia – 1997-99

Causes of death	Annual 'excess' deaths	Per cent of total 'excess'
Coronary (Ischaemic) heart disease	755	23
'Other' cardiovascular diseases (a)	518	16
Chronic obstructive pulmonary disease	374	11
Motor vehicle accidents	368	11
Diabetes	191	6
Suicide	184	6
'Other' injuries (b)	214	6
Prostrate cancer	131	4
Colorectal cancer	117	4
Lung cancer	52 (c)	2 (c)
All other causes	399	12
All causes	3303	100

Notes:
(a) – Excludes stroke and rheumatic heart disease
(b) – 'Other' injuries include all injuries except motor vehicle accidents, suicide, homicide and accidental shooting.
(c) – There were 52 additional deaths due to lung cancer overall(this was made up of 112 additional deaths of those under 70 years outside Major Cities and 60 fewer than expected for those who were 70 years and over). While it accounted for 2% of all additional deaths, lung cancer accounted for 6% of additional deaths of people under 65 years.

Source: Australian Institute of Health and Welfare 2005, Rural, regional and remote health: Indicators of health, Australian Institute of Health and Welfare, viewed 15 Dec 2005, http://www.aihw.gov.au/publications/phe/rrrh05/rrrh05.pdf, p. 100.

• Rural, Regional and Remote health: A study in mortality (PDF - 1873 KB) 

What the data mean

There were an estimated 59,023 registered medical practitioners in Australia in 2002, of whom 92.8% were in the medical labour force (AIHW 2004, 3), Medical labour force 2002 

The practitioner rate rose from 260 to 275 practitioners per 100,000 population between 1997 and 2002. However, considering full-time equivalent (FTE, based on a 45-hour week) practitioners per 100,000 over the period, there was a decrease from 275 in 1997 to 271 in 2002 (AIHW 2004, 8),Medical labour force 2002 

Between 1997 and 2002, the number of full-time equivalent practitioners per 100,000 population, based on a 35-hour full-time working week, decreased for primary care practitioners (from 145 to 134), for specialists (from 125 to 123) and for nurses (from 1,079 to 1,018). The number of full-time equivalent pharmacists increased from 77 to 83 per 100,000 population. Source: National Health Performance Committee 2004, National Report on Health Sector Performance Indicators 2003, Australian Institute of Health and Welfare.

Changes in the supply of all practitioners based in each region varied. Slight decreases in the FTE rate (per 100,000 population) occurred in ‘Major cities’ (down from 315 to 312) and ‘Outer regional’ areas (down from 147 to 146). Conversely, increases in supply occurred for those based in the remaining regions, with the largest in ‘Very remote’ areas (up from 112 to 141), followed by ‘Remote’ areas (up from 129 to 140). There was a slight increase in ‘Inner regional’ areas (up from 174 to 176).

Access to most health workers is generally poorer in rural and remote areas than in the major population centres. Shortages are often more significant in outer metropolitan, rural and remote areas and especially in Indigenous communities. Some rural and remote communities have very limited access to even basic primary care services. Areas of special need such as mental health, aged care and disability services also suffer significant shortages in the face of growing demand.

Separations per 1,000 population increased by 6.1% for public acute hospitals and by 53.7% for private hospitals between 1994-95 and 2003-04. Separations per 1,000 population for public psychiatric hospitals fell by 22.5% between 1996-97 and 2003-04 and there was a 54.5% fall in patient days per 1,000 population (AIHW 2005), Australian Hospital Statistics 2003-04 

In 2002-03, remote areas had higher separation rates for public hospitals than major cities and regional areas while major cities had higher separation rates for private hospitals than regional and remote areas.

Separation rates for public hospitals were highest for patients living in very remote areas (429.4 separations per 1,000 population) and lowest for patients living in major cities (192.1 separations per 1,000 population). Separation rates for private hospitals were highest for patients living in major cities (139.9 separations per 1,000 population) and lowest for patients living in very remote areas (44.8 separations per 1,000 population).

Metal health-related separations with specialised psychiatric care per 1000 population were more than double in major cities and in inner regional areas compared to remote and very remote areas. There is a shortage of mental health professionals in remote and very remote areas.

Standard mortality rates by all causes have decreased for both males and females in all localities between 1992 and 1999. These rates were lower in cities compared to remote and very remote areas. Leading causes of excess death outside major cities include coronary heart disease, ‘other’ cardiovascular diseases, chronic obstructive pulmonary disease and major vehicle accidents.

Data Limitations

Full Time Workload Equivalent (FWE) is a measure of service provision because it takes into account doctors' varying workloads. It is generally considered to provide a good overall indicator of medical workforce supply. FWE is calculated by dividing each doctor's Medicare billing by the average billing of full-time doctors for the reference period. Where the doctor’s Medicare billing is greater than or equal to the mean billing of full-time doctors, then the Full Time Equivalent is capped at one but the FWE is not.

Issues for which this is an indicator and why

Human Settlements — Liveability of human settlements - Human health and well being 

Collectively the three datasets comprising this indicator show the accessibility of health care by the human population.

Further Information

• Australia's Health 2004 
• Medical labour force 2002 

Source: Australian Institute of Health and Welfare 2005, Australian hospital statistics 2003-04, Australian Institute of Health and Welfare, Canberra.

Source: Productivity Commission 2005, Australia's Health Workforce, Productivity Commission, Canberra.