Public versus Private Health Care

Blair Boyer writes about his recent experiences in the public health system during and after the recent birth of identical twin girls and the way in which those experiences have shaped his understanding of the debate about public versus private health care.

A few days before Christmas my wife gave birth to identical twins at the Women's and Children's Hospital (WCH) in Adelaide. Twins are not in our family and in the months between June and December last year we were on a steep learning curve, 'cramming' for raising twins like it were an exam. Our first child was also born at the WCH and we were very happy with the care we received, leaving us in no doubt about going public again. But whereas the birth of our first child saw us admitted to hospital on Saturday and home on the Monday, the birth of our twins was a different matter that gave me cause to look closely at the public versus private health care debate.  This debate is of particular relevance now in light of the Commonwealth Government’s decision to approve private health insurance premium rises of 5.59% on average, which could lead to many Australians cancelling their policies.

In the spirit of transparency, I'll begin by disclosing that our family has private health insurance. It costs about $213 (soon to be $231) per month for a middle-to-upper level of coverage. We have seldom used the coverage and when it came time to choosing where our first child would be born, we made the decision to go public based on the fact that my wife was happy with her GP and didn't feel she needed the obstetrics services offered under private. Not only did we have faith in the public health system but it was cheaper - and I don't just refer to those monthly premiums.  I spoke to several couples about their experiences giving birth in the private system and they all said that the bill at the end of their stay was approximately $3,000, on top of those premiums.  For one couple it was $8,000.

Our decision to go public was vindicated by the excellent care we received at the WCH and the good fortune we enjoyed with a trouble free birth. I might add that my wife had her own private room overlooking the parklands of Adelaide, a view few hospitals in the world could better. And the bill at the end of our stay was $0.  So, you can see why we were quick to choose public again.

And in many respects it was a case of déjà vu. The professionalism of
staff was unwavering and we were provided a heightened level of
attention due to the greater risk associated with this birth. Again my wife had a private room and the midwifery team doted on her in a manner reminiscent of those private health advertisements you assumed were the figment of somebody’s imagination. But three days after the birth it was clear that not everything was right with one of our daughters, and at that point we disappeared down the rabbit-hole of referrals, consultations and a prolonged stay in hospital.

One would be forgiven for assuming that at this point we would have been better off in the private system - in fact I recall asking my wife that very question; and this really typifies the superficial understanding we have of the relative benefit of private over public. The perception that has been constructed is that private health care, and more specifically a private hospital, will give you access to expertise and a level of care not available in the public system.   The truth in some cases is the opposite.

Call me naïve but what I had always assumed based on the prolific marketing of private health companies was that private hospitals were the home of the specialists and that the public system was the refuge of those medicos who couldn’t get a job in the private system.  It’s a terribly ill-informed and prejudiced view to hold, but one built slowly over time by private healthcare companies with deep pockets fighting for a share of a lucrative market – and one never seriously challenged by a public system that can never justify spending dollars on advertisements over delivering health care. 

So when it came time for my wife and me to meet with the paediatric surgeon, we used every contact we had to enquire about his proficiency.  Much to our surprise, we were told almost unanimously that he was regarded as one of the best in his field.   Had we been patients at a private hospital we would have been referred to the WCH at this point to see him.  In fact, because our daughter was being cared for in the Special Care Baby Unit (SCBU) it is likely she would have been referred from a private hospital long before we met with the paediatric surgeon due to this intensive level of neonatal care not being available in the private system.  

After 6 weeks in hospital, and on the advice of the surgeon, we took our daughter home for the first time.  For the next few months she required regular trips to hospital to monitor her development and plan for surgery.  After spending the past 6 weeks wondering what the point of private medical insurance was, we were suddenly acutely aware of its value.  For even though we had opted for a public hospital, that did not preclude us from using our private health insurance to access the paediatric surgeon during those hours he set aside for private consultations, rather than being limited to the strict times that apply in the public system.  This enabled us to not only stick with the surgeon, but also access him at short notice.  The benefit of this has been inestimable as my wife and I have been grappling with difficult decisions around options for surgery that have required lengthy consultations.

So, at this point, wrapped snugly in my middle class safety net, I finally appreciated the damage that will be caused by the increases in private health premiums.  Those who will need long-term access to specialists, but can’t afford private health insurance, will be forced to take a place in the queue.  And this will hit people on low incomes the hardest.  It’s proof that  private health care is not always a waste of money.  But its value is often overstated.  Those fortunate enough to have the time to weigh up its pros and cons before needing to use it should do so carefully.     There is a huge disconnect in Australia between the perception of private health insurance, as projected by the industry, and its objective value.  Put bluntly, most of us naively assume that if you pay more for something, and that something has an element of exclusivity, it must therefore be better than the cheaper alternative. The truth with private versus public health is often different.  The starting point in any evaluation must be the acceptance that the private health sector has deep, deep pockets.  It is also in competition with both the public system, and itself.  This necessitates advertising that often overtly criticises the public health system.  But, conversely, the public system cannot justify such expenditure and its reputation suffers at the hands of negative media that is rarely balanced by positive stories like our own. 

We are incredibly fortunate in this country to have a high quality, affordable healthcare system.  It would be a great shame if the Australian public were beguiled into unnecessarily using the private system to their own financial detriment.  The only way to immunise oneself against the wiles of private healthcare companies is to research plans thoroughly before signing up.  This might alleviate the shock you get upon receiving an invoice for procedures you thought were covered by the monthly premium.  And if you want a balanced opinion on the quality of care in the public system talk to people who have experienced it.  The private companies are banking on the fact you won’t.



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