At this time of year, there is a lot of media attention given to private health insurance and premiums going up. While the media ads are trying to encourage you to join /change to a fund the ads and media attention can have the opposite impact and some people will decide to quit having private health insurance.

I was recently sent interesting information that can be shared:

  • Consumers are reducing full private health insurance – from 53% in 2012 to 42% in 2016
  • Consumers are selecting health insurance products with exclusions – this has risen from 6.5% in 2007 to 37.8% in 2016
  • In the latter part of 2016, the rate of consumers taking up private insurance began to decline.

These changes show that an increasing number of patients do not have private health insurance and so when they are sick or are pregnant they seek public care rather than private health care.

The public sector is already overstretched and underfunded and greater numbers of patients will a further adverse effect on the quality of care possible in the public sector.

From my perspective, the most important difference between public and private is as a private patient you can choose your own doctor, whereas as a public patient you cannot. That means as a private patient a fully trained and experienced specialist doctor is your primary care provider. As a public patient in Sydney, the primary health care providers will most likely be members of the nursing staff (either qualified and trainee) and junior doctors (who may or may not be in a specialist doctor training program). That means that the healthcare providers of you and your baby in the public sector are less experienced and so are more likely to make incorrect decisions about your care. They are still learning how to do procedures (such as Caesarean sections and operative vaginal deliveries) and see you as an opportunity to improve their skills. It is a bit like having a trainee and often unsupervised pilot fly the plane you and your family are passengers on. I suspect most people would not agree to be passengers on such a plane but so often they agree to be patients of trainee hospital staff. The consequences are just as potentially dangerous.

There are some people who are of limited financial means where they simply cannot afford private health care. Historically that is why Australia has had a public health system and compared with public health systems in other countries it is of very good quality.

Balance of Your Health FundThere are others who can afford private health care but do not join because of ideological beliefs. Others choose to spend the cost of health insurance premiums funding lifestyle purchases and pleasures. Such people consider private health funds premiums are not worth it and their money is better spent in other ways.

So many patients when I first meet them have so little understanding of pregnancy and childbirth and no appreciable insight into possible complications. Often, people have been told that as ‘childbirth is a natural event’ as such all should go well and so it is unnecessary to have a private obstetrician. I rejoice with a patient when all does go so well. But I tell patients at their first antenatal visit that childbirth is totally unpredictable. Even if a first pregnancy and delivery went well there is no guarantee that the second will not have some life-threatening catastrophic complication that can occur without any warning. When this complication does happen, it is in a pregnant woman’s best interests that the people looking after her and her baby have the experience and skills to provide the best quality of care possible. She does not want a bad outcome which can have lifelong health implications as a direct consequence of staff not having the experience and skills to deal with the complication, as is more likely to happen when choosing to be a public patient.

As well a specialist doctor is more likely to be able to anticipate a likely complication and in doing so make management decisions so the complication can be avoided or the impact of the complication can be minimised. I am aware of so many bad management decisions made in the public sector which chiefly have reflected the inexperience of the primary health care providers. This is the chief reason I quit being a VMO in the public system. It saddens me that so many people are deciding to join the public system I quit simply so they can save some money and without knowing the implications of being a public patient.

I have looked after many patients who had public care during their first pregnancy and say to me: “Never again”. Either there was a poorly managed complication or they were just very unhappy with the quality of care received as a public patient. They decided, in their second pregnancy, to be private. Their finances had not changed but their priorities had. They now they see the importance and value of being a private patient.

There is more information about the difference between private and public care in the Question and Answer section of my website at ‘Public or private – What is the difference?’

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