Life Wellbeing Private versus public: Unravelling the hospital debate

Private versus public: Unravelling the hospital debate

private versus public hospital
Which sector of care is right for you? Which is better value for money? Photo: Getty
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The decision to choose a public or private hospital for medical treatment is one that divides many Australians.

From nurse-to-patient ratios to infection rates, we decided to get to the bottom of the real differences between them.

The question remains, which sector of care is right for you? Which is better value for money?

One crucial factor of care in any hospital is the number of nurses compared with the number of patients in their care.

Nurse-to-patient ratios are generally regulated, depending on the time of day and the level of patient care needed.

In public hospitals, the minimum ratio is usually one nurse to four patients from the morning to afternoon.

In the evenings, the ratio increases with seven or eight being cared for by one nurse.

But the ratio for private hospitals varies.

Depending on the conditions, one nurse can be caring for up to eight patients at any one time.

Preoperative nurse Alvia D’sa said the ratio was always higher during the night.

“In the private, I think it’s usually 1:5 or 1:6, or 1:7 or 1:8. That’s on day and night, and (shifts) can be quite heavy sometimes,” Ms D’sa said.

private versus public hospital
Comparing nurse-to-patient ratio in public and private hospitals. Photo: Calvin French

Third-year Deakin University nursing student Sarah McDonald said nurses working in the private sector had a greater workload and this translated in patients’ satisfaction.

“The patients aren’t being seen as much by the nurses,” Ms McDonald said.

“There’s lots to do, lots of patients to see and they may not be as happy.”

The examination of maternity care in Australia has highlighted the range of options available for patients.

About 92 per cent of Australian women use either private maternity care, combined maternity care, public hospital care or shared maternity care.

Of the four care options, the public system is the most popular option, with 73 per cent of women choosing it in 2015.

Monash University Adjunct Professor Christine East said she was not surprised that mothers were choosing public hospitals over private.

“I think we give amazing care in the public system. People are so dedicated, work really hard and really want the best for the mum and the baby,” Prof East said.

Public hospitals abide by strict evidence-based guidelines that private ones often don’t.

Prof East said this could be both good and bad for the patient.

Even though there are different guidelines, private hospitals have the capacity to act quickly, helping to relieve mothers of pain through medical intervention.

“I wasn’t always sure that the women got the best deal (in the private sector) … but if they wanted something it happened quickly. If they wanted epidural pain relief they got it, whilst in the public system they might have to wait a few hours,” Prof East said.

Cost is another driving factor many mothers need to consider when choosing between private or public care.

If one is not covered by private health insurance, the cost of private hospital pregnancy and birth can range from $9000 to $30,000.

Even when insured, there are out-of-pocket costs for private obstetricians that can range from $2500 to $12,000.

In public hospitals, Medicare covers most of the care.

In some cases, there may be out-of-pocket costs for medical tests, ultrasound scans and antenatal classes.

However, Australians can often get some money back through Medicare.

Looking at death rates is another way to compare the public and private healthcare system.

In 2014-15, 82 per cent of patient deaths occurred in public hospitals compared with 18 per cent in private, as reported by the Australian Institute of Health and Welfare.

private versus public hospital
Comparing public and private hospital deaths. Photo: Calvin French

This high discrepancy between the two types of hospitals could be related to public hospitals’ higher intake of patients that year.

Other factors that make comparisons of death statistics between hospital types may include their capacity, resources and the type of patients they receive.

Private hospitals are not obligated to release all information about patient deaths, which makes it more difficult to compare the two systems.

When comparing public and private hospitals, funding and expenses need to be taken into consideration.

private versus public hospital
A comparison of public and private hospital expenditure. Photo: Calvin French

In 2008-09, recurrent expenditure for public hospitals stood at $31,323 million compared with $44 billion in 2013-14.

For the private sector, the recurrent expenditure in 2008-09 was $8,137 million and it increased to $12 billion in 2013-14.

Over the years, the recurring expenditure for public and private hospitals has increased.

Public and private hospitals are funded from a range of sources, reflecting the types of patients they treat and the services they provide.

The proportion of funding by the Federal Government in 2015-16 was 37 per cent for the public system and 30 per cent for private.

During the same time, the Victorian Government gave 54 per cent of its funding to public hospitals while only 5 per cent of funding went to private hospitals.

However, private hospitals also received 46 per cent of health insurance funding in 2015-2016.

private versus public hospital
Comparing spending in public and private hospitals. Photo: Calvin French

In 2015-16, the recurrent expenditure of public hospitals rose even more to $61 billion, of which 61 per cent ($37 billion) was spent on staff salaries.

In comparison, the recurrent expenditure of private hospitals was more than $13 billion, almost half of which (49 per cent) was spent on staff salaries.

While comparison between some factors of private and public care is possible, others, such as infection, are not.

Information on the serious bloodstream infection, staphylococcus aureus bacteraemia (SAB), is only available in the public sector.

Rates of SAB in public hospitals have declined over the past six years.

In public hospitals, SAB rates have decreased from 1873 cases in 2010-2011 to 1502 in 2016-2017.

The national benchmark for SAB is 2.0 cases per 10,000 days of patient care for public hospitals across Australia.

The national rate of SAB during the same time period was 0.76 per 10,000 patients.

Public and private hospitals differ in many elements, including but not limited to those The New Daily chose to investigate.

To decide which sector of care is the right one, it is important to consider these differences, but also one’s health condition, financial status and proximity to the hospital.