Waiting for healthcare? These factors will determine how long you wait in 2023

January 10, 2023

Opinion editorial by Juan Paolo Legaspi, Deputy CEO of the Victorian Healthcare Association. This article was first published in the The Age.

If you’re starting 2023 on a waiting list for healthcare in the public system, you’re not alone. The Victorian government’s most recent data shows there were nearly 85,000 people waiting for elective surgery at the end of June 2022 – about double the waiting list before the pandemic reached Victoria. Many others were waiting to see medical specialists such as paediatricians, neurologists or psychiatrists.

Before the pandemic, we could predict with reasonable precision how many patients the public health system would see for different procedures and specialist attention at the start of the year, and how long those people would wait.

But the pandemic has created uncertainty in more ways than one. While Victorians needing urgent, life-saving care will almost always receive treatment quickly and on time, a growing proportion of people with less urgent problems, such as those needing joint replacements, have been waiting longer than clinically recommended times for care since 2020.

The following factors are responsible for this, and are likely to blow out waiting times for less urgent care this year.

The first issue is COVID-19 demand. The uncomfortable truth is, no one knows what the pandemic will deliver this year, but the virus continues to harm many Australians. Nationally, there are currently about 3,500 people in hospital with COVID-19 – more than half of the 5500 people who needed hospital care during the winter peak last year.

In Victoria, we have about 545 people in hospital with COVID-19 – enough to fill every bed of a large Melbourne hospital. This means people waiting for surgery and other care are likely to wait longer than before the pandemic because there are fewer beds and staff.

New variants are also creating unusual patterns of emergency demand for our public hospitals, with multiple peaks for COVID-19 infections throughout the year – not just in winter, which used to be the case with respiratory viruses. This alone is a worrying phenomenon, as it makes it harder for hospitals to schedule surgery and other care that might clash with new, unexpected peaks in demand due to COVID-19.

And then there’s the potential for new and more severe variants this year. This possibility sits alongside other variables that could turn for or against us this year, including how many people get vaccinated, the availability and efficacy of new vaccines, the prevalence of long COVID and its impacts on demand for healthcare, and the efficacy of treatments for COVID-19 and long COVID.

A shortage of trained health workers, exacerbated by COVID-19 furloughing, remains a huge problem for our public health system and limits how much care services can provide. While recent data from the Australian Health Practitioner Regulation Agency showed migration of internationally trained health workers to Australia is trending up towards pre-pandemic levels, our public health services are still desperate for staff.

In August, the Victorian government’s Skills Plan said Victoria needs 65,000 new workers to join the health and community care sector by 2025 to meet demand and replace people retiring. That’s about 22,000 per year. To start building our own locally trained workforce, the state government has created a range of incentives to attract students into health courses, and it will pay graduate nurses incentives to work in the public health system instead of the private system. These policies should boost our workforce in coming years, but we won’t see the benefits for some time.

The big question for our health sector this year is what the Commonwealth government will do to improve Medicare, so we can try to prevent more people getting sick in the first place or reduce the severity of their illness, so they don’t need expensive hospital care.

The pandemic has put a spotlight on pre-existing problems and inefficiencies across our complex health system, including insufficient funding for GPs and other community-based health services to keep people well, or better manage their health so they don’t experience crises requiring hospital admission.

Last week, Premier Daniel Andrews implored the Albanese government to prioritise reforms to the health system in 2023 because the status quo is unsustainable for state budgets. He did this while opening a new state-funded GP service in Heidelberg – the first of 25 designed to steer less urgent patients away from crowded emergency departments. The federal government is responsible for primary care, including GPs, so it’s unusual for the state to be paying for it, and shows how worried state governments are about demand for hospital care.

It is time for the Commonwealth to contribute more funding to hospitals, and to reform and fund out-of-hospital care, so it is more accessible, sustainable and focused on achieving good outcomes for people, rather than quick transactions. This should include more recognition and funding for Victoria’s 81 community health services which already provide multidisciplinary healthcare to hundreds of thousands of Victorians.

On a world scale, Victoria’s public system has held up extremely well under the sustained pressure it has faced in recent years. But it’s going to take many years to get waiting lists back to pre-pandemic levels. In the meantime, we need the Commonwealth and state governments to urgently reform our health system, so fewer Victorians are languishing on waiting lists for many months, and sometimes years, to get the care they need.