The Victorian government concedes the state's health service is struggling to get patients into hospital, with a report showing emergency waiting times falling below performance standards.
Paramedics arrived at 73 per cent of the most serious cases within the required 15 minutes in 2012/13, well below the target of 85 per cent, according to Ambulance Victoria's annual report released on Thursday.
Ambulance Victoria chief executive officer Greg Sassella blamed ambulance ramping at hospitals as he acknowledged the failure.
"A key challenge remains the long periods of time it can take for paramedics to hand over patients at hospital emergency departments," he wrote in the report.
Paramedics also failed to meet response time in the bush where they attended 78.1 per cent of jobs in areas with a population of less than 7500 within 15 minutes, below the 90 per cent target.
The figures show that fewer than 77 per cent of ambulance patients were transferred to hospital within 40 minutes.
Health Minister David Davis said the state government was increasing its spending on the ambulance service.
"Transfer times remain a challenge, there's no question about that," he told reporters.
"(But) the additional resources are helping."
Mr Davis conceded the figures needed to improve.
"Sometimes it's the physical infrastructure, sometimes it's a cluster of work, sometimes it is that we just need to have better flows through our hospitals," he said.
The state opposition said the ambulance system is in crisis.
"On every measure our system is worse today than it was a year ago, our system is worse today than it was three years ago," Opposition Leader Daniel Andrews said.
"The premier needs to acknowledge that our health system is not better. It's worse than it's ever been.
"Patients are suffering, patients are dying."
Health department figures show 49,262 people were on the state's elective surgery waiting list on June 30, an increase of 3100 people on the previous year.Mr Davis said the federal government's budget cuts were having an impact on the figures.