Western Australia Spends the Least Per Capita on Ambulance Services – What If That Changed?

How much does Western Australia spend on ambulance services?

Western Australia (WA) has a few remarkable statistics, especially regarding its size. WA covers approximately 2.53 million km², almost a third of Australia (a little over 12 Great Britains or 3.5 times the size of Texas!), yet has a population density of just 1.2 people per km². Despite that size, more than 80% of Western Australians live in Perth,¹ which is also one of the most isolated major cities in the world. This leaves the remainder scattered across an enormous area, the immensity of which is hard to grasp until you’re 20+ hours of driving into a Northwest WA road trip and still nowhere near a state border.

There’s another, perhaps less well-known statistic worth adding to that list. Year after year, WA comes in at the bottom of the national rankings for per capita ambulance expenditure – or in other words, WA spends the least amount per person on providing its ambulance service of any state in Australia (see Figure 1). In 2024–25 (the most recent data available), WA spent approximately $190 per person on providing ambulance services, compared with a national average of $233.² This isn’t isolated, and it isn’t new. In fact, when I first arrived, I recall statements that WA was quite proud of having “the most cost-effective” ambulance service.  

As those around me at work can confirm, I’ve become increasingly frustrated by the way terms like ‘cost-effectiveness’ are thrown around in healthcare, developing an almost instinctive recoil to the term.

Of course, spending more does not necessarily mean better services, but neither should spending less automatically be celebrated in isolation as evidence of efficiency. In a state like WA, the tyranny of distance and the realities of serving small, widely dispersed communities provide some very good reasons to expect healthcare to cost more per person, not less.

Today’s post is a bit of a review of the limited publicly available data on public spending for ambulance services, coupled with some amateur financial modelling and a proposal for the future – all of which form a thought experiment focused on answering one simple question: What would ambulance provision in WA look like if we didn’t spend the least (per capita) nationally?

A disclaimer on today’s post (click to expand)

This post is political.

It is also critical in places about the way successive WA governments on both sides of politics have funded ambulance services in WA and, more recently, engaged (or failed to engage) in public discourse and transparency. Consequently, this post warrants a disclaimer.

The views expressed here are entirely my own and represent personal commentary on government policy, public expenditure and health service funding. They do not represent the views of any organisation with which I am employed or affiliated.

Importantly, this commentary concerns the funding and policy decisions of the Western Australian Government. WA’s ambulance system involves multiple public and contracted service providers that operate under different funding and service delivery arrangements.

Questions or criticism about how much governments invest in ambulance services are distinct from questions or criticism about how those services are delivered and by whom.

This post should not be interpreted as an assessment of, or conclusion about, the quality, efficiency or performance of any such organisation contracted to deliver ambulance services in WA..

I am not an accountant nor an economist – and if I’m being honest, I have an Amazon problem

As my lovely wife will attest, I might be the last person who should be lecturing on fiscal responsibility. I have, on more than one occasion, received Amazon or eBay packages I don’t recall ordering during a midnight scroll (surprise parcels, anyone?). I am also a clinician and a health researcher, not an accountant or health economist, and honestly, as far as numbers go, I only really tolerate statistics if I can make a plot or, even better, a pretty map.

In saying that, I do work with other types of public data routinely and have a reasonable understanding of how to interrogate it, recognise its limitations and draw some data-informed conclusions. I have also never missed a mortgage payment (yay) and have previously been tasked with balancing multi-million-dollar budgets (admittedly with amazing expert support).

So, consider this fair warning that the following sections contain numbers and comparisons that should be considered data-informed ‘back-of-the-napkin’ calculations. They rely on numerous assumptions, imperfect comparisons and publicly available data that do not always provide the level of detail needed to understand where ambulance funding actually goes. This is made considerably more difficult by the WA Government’s ongoing limited transparency regarding ambulance funding arrangements.^3,4

My intention isn’t to present these numbers as any form of a definitive financial analysis, and the calculations and proposals here aren’t going to win me the Sveriges Riksbank Prize, but I do hope this can serve as a thought experiment for how, in the grand scheme of a State Government budget, a very small investment could revolutionise ambulance care in regional WA.

I also hope this encourages better-informed public discussion, greater transparency and more meaningful scrutiny of how we fund ambulance services in WA. I’d welcome corrections, challenges and fact-checking by someone with some expertise. I’d particularly welcome the Minister for Health or the Minister’s office challenging these numbers. I’d be delighted to hear where I’ve gone wrong. At the very least, it would mean engaging in public discussion about ambulance funding rather than avoiding the questions being raised.

Rural health is expensive, and that’s okay

One of the (many) challenges with providing healthcare in rural and remote areas is that it is inherently more expensive.⁵ Urban areas benefit from economies of scale, short distances and a comparatively abundant healthcare workforce. Hospitals, ambulances, equipment and healthcare professionals can serve relatively large populations within comparatively small geographical areas.

Rural and remote areas have the opposite problem. Communities are separated by enormous distances; patient numbers are often relatively low, and attracting and retaining healthcare professionals can be difficult and, especially in remote WA, expensive. Even services with visiting healthcare professionals from the city aren’t cheap to run.

There is also an unavoidable cost to having a service available in case someone needs it – regardless of whether it is used. A small rural maternity or emergency department still needs staff, equipment and infrastructure, even if it sees a fraction of the patients of a metropolitan hospital.

But this raises an important question of equity. Recent work examining rural health equity in Australia challenges the assumption that poorer access to healthcare is simply an unavoidable consequence of rural geography, rather than something shaped by decisions about where and how we invest in services.⁵ Spending the same amount per person isn’t equitable if the opportunities to access healthcare remain vastly different depending on where someone lives – and equity, particularly for regional health, is a core value within WA Health.⁶

We see these higher costs reflected in WA’s broader health expenditure. In 2024-25, the WA Country Health Service (WACHS) spent approximately $3 billion providing healthcare across regional WA. That works out to around $5,090 per country resident, compared with approximately $3,475 through Perth’s three metropolitan health services (or around $3,970 if we also include the Child and Adolescent Health Service) (Figure 2).

Admittedly, these figures aren’t a perfect comparison. Regional WA residents regularly receive care in metropolitan hospitals (they have to; WA has no tertiary hospitals outside of Perth), and expenditure in a health service area isn’t necessarily spent on the people living in its catchment. Nevertheless, these figures highlight the costs of delivering healthcare in rural and remote areas of Australia, with WACHS spending between 28.3% and 46.5% more per resident (depending on the share of CAHS’s spending attributable to regional health).

None of this means that spending more automatically produces better healthcare, or that every dollar is necessarily being spent effectively. But equally, higher per-person expenditure in rural areas shouldn’t automatically be treated as inefficiency.

Calling a service ‘cost-effective’ simply because it costs less is a rather convenient approach, provided nobody asks whether it’s actually ‘effective’ (or how we measure effectiveness).

So, how much of WA’s ambulance expenditure actually goes towards providing services in country WA?

Unfortunately, that’s a surprisingly difficult question to answer.

While the RoGS data provides overall ambulance expenditure (including the proportion funded by the WA Government), there’s relatively little publicly available information on how that money is distributed between metropolitan and country services.

One of the few useful publicly available breakdowns comes from WACHS, which examined regional ambulance expenditure in 2015-16 as part of the WA Country Ambulance Strategy.⁷ At the time, and noting this data is now a decade old, approximately $194 million (80.6%) was spent on metropolitan ambulance services, compared with $47 million (19.4%) on country services. That’s around $96 per metropolitan resident and $87 per country resident.

The 2022 parliamentary inquiry into ambulance services provided a more recent breakdown of country expenditure (without a metropolitan comparison), covering 2020–21.⁴ Of the approximately $82.5 million in reported costs, $30.9 million went towards paid and community paramedic salaries, while $11.8 million was attributed to capital expenditure (keep these two numbers in mind; they’re important later, I promise).

Unfortunately, this 2022 figure isn’t directly comparable to the statewide RoGS expenditure, particularly because of differences in how capital expenditure is accounted for, so using it to calculate the proportion spent on country ambulance services falls outside my unqualified DIY health-economist skill set. However, based on my (very tentative) estimates, it was still likely about 16-21% of total expenditure on regional services.

But from what we do know, what might this split look like today?

If we take the approximately $572 million in statewide ambulance expenditure estimated from the latest RoGS data,² and assume the metropolitan/country proportions from 2015-16 have remained relatively stable, we get an indicative expenditure of $461 million in metropolitan WA and $111 million in country WA. That works out to approximately $190 per resident in both areas.

Now, I’m rather sceptical that the actual expenditure is quite so evenly distributed. We’re applying a decade-old expenditure split (80.6%/19.4%) to contemporary figures that aren’t entirely comparable, and funding arrangements have likely changed considerably as a result of the 2022 parliamentary inquiry (noting again the lack of government transparency here). Regional WA’s population has also fallen from approximately 21% to 19.5% of the state total over this period,¹ which largely explains why applying the old expenditure proportions produces such conveniently equal per-capita figures.

So, I certainly wouldn’t interpret this as evidence that metropolitan and country ambulance expenditure is now equal, let alone equitable. But with the limitations of publicly available data, it gives us a rough starting point for exploring what different levels of investment might look like.

If we build on these assumptions, though, for argument’s sake, what might it look like if WA simply spent the national per-capita average on ambulance services, rather than consistently coming last?

My proposal to the WA Government

If you’re a WA politician, this bit is especially for you.

My proposal is modest and, I feel, fairly uncontroversial. What if WA simply spent the national average per person on ambulance services?

According to the latest RoGS figures,² that would mean increasing expenditure from approximately $190 to $233 per resident. Across WA’s population of around 3 million people, that’s an additional $130 million annually (rounded for ease of numbers). In terms of total cost, this would raise WA’s annual ambulance expenditure from $572 million to $702 million annually.

It is also worth highlighting here that the WA government itself doesn’t currently spend $572 million on ambulance provision.

Currently, the WA Government contributes only about $292 million of that figure. The remainder comes from sources such as ambulance transport fees, which account for 35.3% of WA’s ambulance service revenue, the highest proportion nationally and more than double the Australian average of 15.9%.

So, this proposal would only increase the assumed direct government contribution to approximately $422 million. For context, this is in the same ballpark as what the South Australian Government reported as spending in the last reporting year (an equally rural, but much smaller and less populated state).

Now, $130 million is certainly not pocket change for you or me, but in the context of WA’s annual health expenditure of more than $14 billion (or $14 thousand million), we’re talking about less than 1%. Hardly an insurmountable figure, particularly when we’re talking about an essential service. Even more so when we consider that WA has been boasting about year-on-year multi-billion-dollar budget surpluses (Figure 3), which is at least partly due to the resources sector and the GST redistribution – both sources of income that should be supporting regional WA.

Take a close look at Figure 3. it’s easy to miss the orange bar showing how much $130 million is in comparison.

Here’s the second part of my proposal: Using that $130 million to provide an annual increase of $30 million for metropolitan ambulance services and $100 million for country WA.

Using our admittedly slightly questionable financial modelling from earlier, that would increase metropolitan ambulance expenditure to approximately $491 million annually, or $203 per resident. Country expenditure, meanwhile, would almost double from $111 million to $211 million, reaching approximately $360 per resident.

Rather than treating equal per-capita spending as the desired outcome for regional WA, I want to see us spend more – and this is why.

Remember those 2021 regional ambulance expenditure figures I promised would become relevant? $30.9 million annually on paramedic salaries and $11.8 million on capital;⁴ we can build on these to see how much impact this level of funding increase can have.

If we allocated $62 million of our additional $100 million towards paramedic staffing, that would theoretically be enough to fund up to two additional 2021-level workforces. In other words, at historical salary costs, we could potentially triple the 2021 regional WA paramedic workforce.

Of course, there are a stack of limitations to this claim. Wages have increased (although not as much as inflation) since 2021, and there has been some increase in the number of paramedic positions in regional WA; employing additional paramedics also involves more than simply paying their salaries. Vehicles, equipment, training, support staff and recruitment all cost money. So, I’m not suggesting $62 million would literally triple the current workforce overnight. But it does illustrate the scale of what modest additional investment could achieve.

And we’d still have approximately $38 million left over for infrastructure, equipment and other costs associated with supporting regional volunteers. One issue I have been very public about for quite some time is the lack of capital funding for regional ambulances,⁸ putting pressure on a system that is already incredibly cheap for the State Government.⁹

Compare that with the $11.8 million in annual country capital expenditure reported in the parliamentary inquiry.⁴ Adding $38 million would bring the illustrative capital investment to nearly $50 million, more than four times the 2021 amount.

Imagine what that could mean for regional ambulance stations, vehicles and equipment.

Perhaps we could even reach a point where volunteers no longer need to rely on community fundraising to finance essential infrastructure.^4,8,9

Final thoughts and comments

What I’ve presented here is an entirely hypothetical allocation of additional government funding, not a fully costed budget. There are also some fairly obvious limitations to the calculations, not least the use of data that are more than five (sometimes closer to ten) years old in places. Some of the limitations come down to my limited accounting expertise, but even with that expertise, the lack of publicly available information makes this exercise difficult.

One particularly interesting and unintended comparison emerged from all this. Unlike WA, the Queensland Government publishes annual detailed regional ambulance cost data. Using Queensland Ambulance Service’s published regional data,¹⁰ I calculated an estimated annual road ambulance expenditure of approximately $356 per resident across its Far Northern and Northern regions –  remarkably close to the $360 per capita in regional WA presented in my hypothetical model.

That wasn’t the target of my calculations, and the figures aren’t directly comparable, but it’s an interesting point of reference from another state facing similar geographical challenges.

Ultimately, the precise figures are less important to me than the questions they raise.

Equity in healthcare isn’t about spending the same amount on everyone. Instead, it is about ensuring people have equal opportunities to access care, regardless of where they live. For ambulance services in regional and remote WA, that means investing considerably more per resident than we do in Perth.

It is my view that as a community, Western Australia needs to engage in a more serious discussion about whether we’re investing enough to provide the services regional communities actually need.

As always, stay curious and be excellent to each other.

References

Show References (10)

1.            Australian Bureau of Statistics. Population estimates by SA2 and above, 2001 to 2025 [Internet]. 2026. Available from: https://www.abs.gov.au/statistics/people/population/regional-population/2024-25/32180DS0003_2001-25.xlsx

2.            Ambulance services – Report on Government Services 2026 [Internet]. Available from: https://www.pc.gov.au/ongoing/report-on-government-services/health/ambulance-services/

3.            Ambulance Employees Association of Western Australia and the Department of Health [Internet]. 2026. Available from: https://www.austlii.edu.au/cgi-bin/viewdoc/au/cases/wa/WAICmr/2026/15.html?context=1;query=D0152026;mask_path=%20au/cases/wa%20au/legis/wa%20au/other/walrc

4.            Standing Committee on Public Administration (Committee). Delivery of Ambulance Services in Western Australia: Critical Condition [Internet]. Western Australian Government. Report no.: 37. Available from: https://www.parliament.wa.gov.au/Parliament/commit.nsf/(Report+Lookup+by+Com+ID)/F488C9C6E5A266FE48258847000D1C02/$file/pc.all.220519.rpf.037.xx.pdf

5.            Hayes, Coxon, Bye. Rural and remote health care: the case for spatial justice. Rural Remote Health. 2025. https://doi.org/10.22605/RRH8580

6.            WA Country Health Service – Vision and values [Internet]. Available from: https://www.wacountry.health.wa.gov.au/About-us/Vision-and-values

7.            Western Australian Country Health Service. The-Country-Ambulance-Strategy-Driving-Equity-for-Country-WA [Internet]. Western Australian Government. Available from: https://www.wacountry.health.wa.gov.au/~/media/WACHS/Documents/About-us/Publications/Strategic-plans/The-Country-Ambulance-Strategy-Driving-Equity-for-Country-WA.pdf

8.            ABC Perth. Is it fair that country paramedics have to fundraise for a new ambulance? Facebook [Internet]. 2025. Available from: https://www.facebook.com/watch/?v=1413322280358796

9.            WA MP “gobsmacked” new ambulance requires fundraising amid $3b surplus. ABC News [Internet]. 2025 May 23. Available from: https://www.abc.net.au/news/2025-05-23/st-john-ambulance-wa-volunteers-fundraise-for-equipment/105318850

10.         Queensland Ambulance Service. Queensland Ambulance Service Performance Statistics [Internet]. 2025. Available from: https://www.ambulance.qld.gov.au/__data/assets/pdf_file/0028/422677/ppi-q4-2024-25.pdf

Financial Data Sources:

In addition to the above references, the following government publications and datasets informed the expenditure comparisons, figures and hypothetical calculations presented in this article.

Productivity Commission (2026). Report on Government Services 2026, Chapter 11: Ambulance Services. National and state ambulance expenditure, government funding and revenue comparisons.

WA Country Health Service. The Country Ambulance Strategy: Driving Equity for Country WA. Historical metropolitan and country ambulance expenditure (2015–16).

Standing Committee on Public Administration (Committee) (2022). Delivery of Ambulance Services in Western Australia: Critical Condition, Report 37. Regional ambulance expenditure, staffing costs and capital investment (2020–21).

WA Health Service Providers (2024–25). Annual reports. Expenditure reported by WA Country Health Service, North, South and East Metropolitan Health Services, and Child and Adolescent Health Service.

Australian Bureau of Statistics (2024–26). Regional Population. Estimated resident populations for Western Australia, Greater Perth and regional WA, including historical population estimates.

WA Treasury (2020–26). Annual Reports on State Finances and the 2026–27 State Budget. Historical budget surpluses, government expenditure and budget comparisons.

Queensland Ambulance Service (2025). Performance Statistics, Quarter 4, 2024–25. Regional road ambulance activity and expenditure used for the Queensland comparison.

Note: All hypothetical expenditure allocations, per-capita estimates and funding scenarios are the author’s calculations using these publicly available sources. They are illustrative estimates, not officially reported expenditure or costed funding proposals.