Of the 762 public hospitals in Australia, 71% have fewer than fifty beds. Hospitals in smaller rural towns were, in most cases, built decades ago, and little or no attempt has been made to redesign these hospitals or their role. There is a paucity of research related to the future of these hospitals in Australia and internationally. This research investigates the role of the smaller public hospitals and aims to contribute to a better understanding of factors driving change and characteristics that assist in sustaining this considerable health infrastructure.
A sample of 25 smaller rural hospitals was examined in detail through quantitative analysis of retrospective data over an 11-year period. The literature review identified the need for an instrument or measure to determine whether a smaller public rural hospital was responding to the contemporary healthcare needs of its catchment population and was sustainable into the future. The Hospital Supply Index was developed and tested through this study to address this gap.
The study concluded that there is little direct relationship between Local Government Area catchment population growth and smaller hospital demand and supply. The population that mattered was the township in which the hospital was situated. Smaller hospitals were admitting more patients categorised as medical, subacute, chronic and rehabilitation. The trended age profile of patients in small hospitals had changed. The closure of surgical and birthing services was found to have an important impact on the future of smaller hospitals. Proximity to a larger hospital had an impact on the mix and volume of care of a smaller hospital – the closer the distance, the more profound the impact. The study demonstrated that the size of the hospital is a good predictor of its sustainability. Hospitals that had reinvented themselves were the exception to the trends. The Hospital Supply Index, developed as part of this study, was shown to be an effective indictor of community reliance on, and use of, a hospital.