Private vs Public Care for my Pregnancy

Why should I go private rather than public to have my baby?

Some of my friends are going public, usually for financial reasons. They are encouraging me to do the same. What are the main differences between private and public pregnancy care?

Answer

public vs private

Private health care offers obvious benefits that are not available through the public system. While it is more expensive the features and benefits mean that being a private patient with me at the San or Norwest Hospital is very worthwhile.

A number of years ago I resigned from working as a specialist obstetrician and gynaecologist in the public system. I always endeavour to provide the best quality of care possible. I could see that there was not the same agenda in the public hospital. I could see a gradual deterioration in the quality of patient care provided in the public sector, and from what I have been told this has not improved. I saw nursing and resident doctor public patient management errors which in some cases resulted in profound adverse outcomes, even in avoidable cerebral palsy. Even though I was not directly involved in these public cases, some of these patients were admitted on days when I was “on call” and so I took these matters personally. Also some of my own private patients had concerning errors of nursing management that I had to sort out.

The public hospital staff morale was low and overall there was not good cooperation and teamwork between the nursing and medical staff. The equipment and facilities were getting worse and inferior to that available in the private sector. So I resigned and within 1 year six other obstetricians also left the same public hospital. I haven’t been happier. I can provide the personalised excellence in care that I value and do know my patient’s value. I have the support of excellent private hospitals with excellent facilities and nursing staff and other hospital staff who are keen to cooperate in the best interests of the patients.

I regularly have new antenatal bookings of patients who went public with the first pregnancy but because of a bad experience and often bad outcome would not do that again. Indeed some still don’t have private insurance when they book with me but there is no way they would entertain the idea of going through the public system again.

Some key differences between public and private are:

As a public patient you will have…

  • No choice of doctor. You are not entitled to choose who will look after you. There is no one person responsible for your care either as a doctor or nurse. This means you will have a lack of relationship with most hospital staff and you usually soon realise you are just one of many patients. You may have certain requests, concerns and anxieties. Even if you find someone who is sympathetic at a clinic visit and who makes notes about these matters it is likely that this person is not going to be available to see you at most other antenatal clinic visits or when you are in labour.
  • It is more likely you will be managed by staff who are strangers when you are in labour. There is often a lack of communication, lack of explanation of what is happening and often the comment is made by public patients that their requests and wishes were not considered. This can be a huge frustration, great fear, resentment and errors in management because of lack of communication. I know of disastrous consequential results. For these reasons public patients often prepare a ‘birth plan’. A written down birth plan is not necessary with me as we should have discussed and worked through management issues and your requests before the big day. That is one aspect of personalised private care.
  • Trainee staff as primary care providers. Medical staff assigned to look after you and your baby are usually still ‘training’. Residents and registrars are training to become specialist doctors and the competence of your care and increased likelihood of errors in your management and the management of your baby can reflect this. The nurse assigned may be a student midwife, who is training to become a midwife. One reason the public system exists is so trainee hospital medical staff can get clinical exposure to patients that they can use to develop their specialist skills. Being a public patient you and your baby are “training material” for these trainees. This implies a greater incidence of poor judgement, clinical errors which are made at your and your baby’s expense.
  • Often minimal specialist obstetrician input in your care. You will be admitted on the date of call of a specialist obstetrician doctor. Often this specialist obstetrician (who you have not chosen and who may not be very good) is not even aware of you and your management. Your care is by the nursing and junior medical staff who are supposed to contact this specialist obstetrician when there is a problem or they are out of their depth with a situation.
  • Unnecessary mistakes. Sometimes the nursing and junior medical staff don’t call for help when there are complications of your labour because they feel others will consider them a failure in their management and they don’t want to admit they need to call for help. Many public midwives hang onto patients too long because of ego. Also, some obstetrician specialists make it known that they resent being called about public patients. Sometimes the junior staff doesn’t recognise the gravity of a pregnancy/labour complication situation because of their lack of experience. Sometimes the specialist is casual with a response saying to the junior staff “you sort it out” because he is not interested in providing you with his personal care and also the junior staff need the clinical experience. All these scenarios put you and your baby at huge risk!
  • Pregnancy visits at the antenatal clinic. This usually means long waits in an overcrowded public clinic, being seen by whoever is available, a quick visit, mistakes in management decisions and no relationship or ability to relate to a professional who really cares and you can really trust.
  • Not able to have personalised management decisions. It is not unusual for a patient to request an induction or even a Caesarean section and other care decisions for ‘other than’ medical reasons. This is not possible in the public system. The hospital staff bias can be motivated by the staff having a personal bias towards one style of management irrespective of whether you share that view. Also, the hospital bias is considerably motivated by the public hospital needing to report statistics to the NSW Government Department of Health and the Department of Health wanting to keep down hospital costs. It is cheaper for you to have a vaginal delivery than a Caesarean section delivery.
  • No male circumcision option. There is now no opportunity for your newborn son to be circumcised if you request this in a public hospital.
  • Inferior equipment. Often equipment purchased and available is less numerous and of an inferior quality to that in large private hospitals such as the San and Norwest Private.
  • Hospital facilities and stay. The quality of accommodation is usually inferior. There are usually more patients per nurse and so less one-on-one nursing time with you when learning new mothering skills. Often to save bed costs you will be discharged home sooner than in the private hospital, and often before you feel ready.

As a private patient with Dr Sykes as your obstetrician

  • This web site especially the Pregnancy care and How we are different sections highlight many of the differences and features of our care of you.
  • Quality care by me. In contrast to a trainee obstetrician, I am a fully qualified obstetrician with many years of experience and exposure to a vast range of pregnancy, labour and birth developments. That implies you can expect expert competence in your care that will help make sure you have the best outcome for you and your baby.
  • Personalised care. Only I will do your antenatal pregnancy visits. You will have to wait much less time to be seen. I will always endeavour to give you adequate time and communicate with you effectively. I value you as a person and the privilege to be your doctor at this very special time.
  • Excellent support staff. I chose my two secretaries very carefully. I had 100’s of applicants for the positions. I was looking for the right staff to support me in your care. While having the right professional qualifications both are happily married, are mothers, are of an age group similar to you, are warm and caring and keen to help.
  • Ultrasound scans in my office public vs private ultrasoundusing the best quality scanner at each visit with you having the opportunity to get a copy of your baby’s images.
  • Labour care. While you will be assigned a midwife in labour. I have found private hospital midwives cooperate much more in working with obstetricians than those in the public sector. She will keep me informed of your progress and developments. I will be responsible for your care and will personally deliver your baby whenever possible. There will be a great emphasis on making your labour and birth a joyful personalised experience with an excellent outcome.
  • Special requests such as induction, Caesarean section and circumcision of your son can usually be agreed to.
  • Hospital benefits. Better quality facilities at both hospitals and with better and more numerous equipment and more comfortable accommodation. You may go home earlier than usual as long as all is well, or you can stay the full usual stay.

It is your decision

Often you will have input from some very vocal and opinionated people trying to influence you. Remember it is your pregnancy and it is your baby. These people are motivated often by their own ideological and political views (the ‘public is best’ and  ‘support the public system’ lobby). There are others who are not able to afford private themselves and justifying this financial decision publicly not by saying the truth that “they can’t afford it” but that they went public because  “public care is just as good” and “why would you waste all that money?”

The poor condition and underfunding of the public hospital system is common knowledge and logically this must have an impact on the quality of care in the public sector. Indeed senior Labour Party politicians tend to go private in private hospitals themselves even though they publicly advocate for their constituents to do the opposite.

Sometimes it is your husband/partner who tries to persuade you that you don’t need to go private or “we can’t afford it”. The emotional bond with your ‘soon to be born’ baby is not as strong for men and men tend to think more “matter of fact”. But most men want their wife’s best interests and happiness and so will come round and be supportive. The financial and emotional costs if things go horribly wrong will be huge. It is a bit like saying you can’t afford house insurance and when the bush fire happens you regret it as the financial and emotional costs are far greater than the insurance premium cost.

You will find people who have had a bad private sector experience and so conclude “I would have been no worse off being public and it would have been a lot cheaper”. While bad experiences can happen in the private sector, they are less likely because of better resources and the better qualifications of those primarily involved in your care. Also, not all hospital and obstetricians are the same. The San and Norwest Private are both excellent hospitals. I know my practice (‘Obstetric Excellence’) offers aspects of care and service that are not provided by obstetrician colleagues (see How we are different).

It is like so many things in life where you get what you pay for. If you don’t pay anything then you shouldn’t expect much. But when a crisis happens, as can suddenly and unpredictably be the case when having a baby, you want to know that those personally looking after you have the qualifications and experience and are personally interested in you so you can achieve the best outcome for you and your baby.

See also

Posted by Dr Gary Sykes on -

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