A good news story about public hospitals and public healthcare

Last week I had surgery as a public patient in a public hospital in NSW. I’ve lived to tell the tale.

In mid-March I went to my (bulk-billing) GP in inner-Sydney with symptoms of something awry. She sent me for a test at a (bulk-billing) x-ray clinic nearby. I was able to arrange the test for the next day. The ultrasound indicated that I needed to go to a specialist. I got an appointment the next week. This doctor confirmed that I needed surgery. I don’t have private health insurance so would be a public patient on his public list. He gave me a date in June but said there was a chance of cancellations before then. Because I’m not working, I paid under $100 for that consultation. It’s the only money I’ve paid for a sequence of first-rate medical care.

Sure enough, within days a cancellation came up for April, a much more convenient date for me (and good to get it over with asap).

A week before the surgery, I attended the pre-admissions clinic at the hospital. Here I had an ECG, was interviewed by two nurses, a surgical resident doctor and an anaesthetist and had blood taken for a full blood count. I was given an estimated time of three to four hours at the clinic and indeed, I was there for three and a half hours. The waiting rooms were clean and uncluttered. All the staff were friendly, informative and unhurried. I signed Medicare forms for all this.

The afternoon of the operation, I was admitted to the hospital in a bright, clean, uncrowded unit. I was seen by a nurse and then by a surgical registrar. Once kitted up and loaded onto the trolley, I was seen by an anaesthetic registrar who was very friendly and reassuring. My surgeon appeared and had a chat. Then it was off to sleep…

I woke up in recovery and was wheeled back to my room. Yes, my room. I had a room with its own bathroom and a view (not that I noticed much of the view for the first 12 hours.) It also had a television suspended from the ceiling which I could work via remote control. On the second night I watched some old Seinfelds. When I said to a nurse that I was puzzled as to how I’d come by a “private room”, she corrected me. “It’s a single room”, she said. A single room in a public hospital.

Later that first night, two registrars came to talk to me about the operation. They were calm and interactive, answering my questions thoughtfully. The night nurse was a steady and intelligent presence. There was some problem in the middle of the night so she called the resident to see me: another very friendly and reassuring doctor with impeccable bedside manner.

Hospital food is notoriously bad and I’m a vegetarian, which can presage worse than bad, but this time the food was fine – I even scored some gluten-free ice cream.

The day nurses were good-humoured and highly competent. I was visited by the “pain team” – just one doctor, in this case – and after discussion, adjustments were made to my medication. I was visited by the resident doctor twice that post-op day, putting me on some more medication after a further blood test. My surgeon came to see me 24 hours after the op and was chatty.

Morning two, another visit from the registrar. An hour later, another visit from the surgeon. I got the go-ahead to go home, two days early. Smiles all round.

Home is definitely best, but the worst I could say of the hospital was that the plastic-covered beds are uncomfortable and even in a “single” room, it’s noisy. Things beep and buzz and clang all day and most of the night.

Other than that, my hospital experience was one of seamless attentiveness and excellent care.

I know someone who had major, long-anticipated surgery cancelled on the day. Of course I’d be feeling very different about the NSW health system if my own operation had been cancelled (I was told there was a small chance of that happening) or if I’d had to wait several (or more) months. But that didn’t happen.

I know that I’m an informed patient who was able to find the right surgeon. I also know that my surgeon mostly does private work. I’ve ended up wondering if so many people go private for surgery these days that public patients (in some medical areas) get a clearer run.

Many major hospital buildings have been renewed in the past two decades. The amenities and technology in most Sydney hospitals are second to none. I know the same is not available to many rural or indigenous Australians nor to people living in some parts of the metropolis. But I’m not alone in my positive experience – I have a friend who’s had two major, planned operations as a public patient within the past two years and he also had excellent care in an excellent environment (in a different hospital to the one I was in).

I’m still recuperating but  it helps that I feel as if the health system really was geared towards my health – as it should be. And it definitely helps that I won’t be getting any bills. I’m glad not to have private health insurance.


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86 responses to “A good news story about public hospitals and public healthcare”

  1. The Intellectual Bogan

    I have direct and immediate family experience of half a dozen similarly positive stories of the public hospital system. Sufficient, certainly, to make me relatively unconcerned that one of my immediate family members is, basically, uninsurable.

  2. MsLaurie

    Adding more stories – my uncle was treated in Royal North Shore in Sydney… oh, about two years ago? For a severe farm accident which effectively ‘shredded’ his upper thigh, and could have (very easily) been fatal.

    Six weeks in the burns unit (regrowing the skin etc), and not a cent paid. He has nothing but praise for the staff and the level of care, and on returning home to his rural area was connected into the local tiny hospital who arranged ongoing rehabilitation. These days, apart from some scarring, you’d never know he’d been so injured. Not even a limp.

  3. Peter

    I don’t really agree with the public health care system but when I had to get my gall bladder removed I was treated very well. My big gripe was that I had to wait 9 months for the op and by that time I was quite sick and ended up in emergency for two days. Friends from Germany and the US were really shocked ( REALLY shocked ) that I had to wait so long – it’s normally 2- 6 weeks in both countries. Having to go to emergency probably doubled the cost of the op to the community as I then had two extra days after the op as well ( often it’s day surgery or at the most overnight ). And the pain for nine months…etc.

  4. Helen

    You know what I like about this thread – the medical system never gets into the MSM unless there’s a shock horror story to hang it on, while all the many stories of good and appropriate treatment in the public system go untold, because it’s not a “story”. This post goes some way to restoring the balance.

    My son had an accident which damaged one eye and rolled up to casualty in a district which is still classified as “disadvantaged’. He was seen by several competent and polite doctors, who conducted multiple tests to ascertain what was going on. We were referred to the Eye and Ear hospital, which is famous, and we have received fantastic care there including minor surgery. We have never had to wait for an uncomfortably long time. His bill from the whole thing is now $0.00.

  5. Helen

    Oh, and welcome back to the land of Oz, Suz.
    And I hope you recover quickly!

  6. David

    That is excellent.

    I think the public system works very well most of the time but it didn’t for me. I had a hernia. Hernias are usually painless but in my case was causing severe to excruciating pain most of the day most days. Because hernias are usually painless and don’t carry big risks of further harm, surgery to fix them is elective. I was told I would have to wait between 2 and 3 years for an operation to fix it! 2 to 3 years of severe pain almost every day for something easily fixed! I didn’t have private health insurance.
    Anyway, I scraped together all my savings and borrowed money from my parents to pay to have it done privately. Cost me about $7000-$8000. Certainly worth it! The trouble is that there are people who have to wait years for elective surgery that they really do need and who can’t afford to pay for it. I don’t think it works very well for them.

  7. suz

    Where do you live David? And can you give us a breakdown of what the $7-8000 went to? Did you get any money back on Medicare?

  8. Vidar

    Can’t speak highly enough of a public system that fought tooth and nail to help both my mother and father through cancer (different cancers at widely different times) and then the care and comfort they gave when each lost the fight and couldn’t go on.

  9. David

    In Sydney. Ended up going to Canberra for the op though – could get in quicker I think and had family there who could look after me. I don’t really remember the breakdown – hospital fees, surgeons, anaesthetist, drugs etc. I got some back from Medicare but not a whole lot – about $1500 maybe.

  10. Fine

    I hope you’re feeling well, suz. My only personal experience of the public system was an elective procedure. The care was timely, excellent and didn’t cost a cent. I refused to be blackmailed by Howard into buying private insurance. Public health care is a right and I oppose any measure that weakens it. I hated the gradual introduction of the idea that public was for losers. Helen is right. We only hear the bad news stories, not the common experience of excellent care.

  11. Polyquats

    Our family has had a few medical emergencies, and generally I agree that our health care system is excellent.
    We did have some funny experiences with cross-border issues though. My daughter has a hip disorder, and had been monitored in Queensland for years before we went to Sydney. In NSW we couldn’t even get an appointment with an orthopaedic surgeon. Her hip deteriorated while over the 18 months we were in Sydney, but was fixed in a few months after returning to Queensland.
    But in reverse, my daughter’s father had been treated palliatively for a heart condition in Queensland. When he came to visit us in Sydney, obviously unwell, it took only a few weeks to organise a triple bypass. I suspect his shoddy treatment in Queensland might be because he is Aboriginal, but I hope I’m wrong.
    I think that the real problem with our health care system might be the shortage of specialists, the blame for which belongs squarely with their guilds.

  12. The Intellectual Bogan

    Some of my family experiences have been for surgery of a similar degree of electivity as David’s hernia procedure. In fact, one was a hernia procedure. Waiting times (in WA) have been weeks rather than even months, let alone years. In the case of a procedure for a (slow growing) malignant tumour, the wait was days.

    Maybe Mrs Bogan and I are lucky in having GPs with some degree of pull in the system, or maybe WA’s waiting lists are just short. Either way, waiting times here offer no incentive to forsake the public system.

  13. Razor

    I wouldn’t be wothout Private Health Insurance.

    Clavicle in 8 pieces after cyclist (me) v car. Excellent initial care in Emergency Department. Told that I had to wear a sling for four weeks to wait and see if healing would commence (yeah right – 8 pieces!!) – then maybe an operation if not knitting.

    Grey with pain and a self-employed small business owner I fortunately was able to be operated on by a surgeon of my choice (the guy who does the AFL players here in Perth) and was out of sling and back behind desk within a week.

  14. Fine

    Razor, I wonder what difference you think it would have made in your treatment not to have private insurance?

  15. Chookie

    I was very glad to be in a public hospital for the birth of the Twig when, after he was born, I went from ordinary first-time mother to eclampsia case with no warning at all. My small local hospital gave me the best possible treatment for my condition (magnesium sulphate — there are alternatives, but this is the best anticonvulsant). The staff decided that as it was a quiet night in Delivery, I could stay there under close observation instead of being moved to ICU and being disturbed by the Machines That Go Ping. Small public hospitals can do this kind of stuff. (Private hospitals aren’t always equipped for things going wrong suddenly.)

    However, as I was now a high risk patient, the Sprig had to be popped out at a bigger hospital. I did my antenatal clinics at the local hospital and my records were transferred to the big one at 36 weeks. Being a librarian, I noticed that the medical records systems had systemic faults that were potentially dangerous (as well as annoying). I wrote a letter to them about these faults. Be interesting to see if they were able to change anything. As with many other parts of the public service, the people are great but are hindered by badly-designed systems.

  16. Razor

    Fine – I would have had to wait 1 month in agony before they decided to put a plate in my shoulder. In the mean time I would have barely been able to work due to the strength of pain/pain killers I needed to take.

    Any part of that you don’t undestand or can’t see the downside on?

  17. Sally R

    “I wouldn’t be wothout Private Health Insurance.”

    Razor, would you be without public healthcare?

  18. rf

    I had a longish taste of the public health service from rural and remote to the metropolitan tertiary hospitals and like many others here my experience was good. Not perfect but good. I could have ‘gone private’ but all that would have entitled me to was a paper each day (and the West Australian at that) and ‘better’ TV i.e. more channels over and above what I had as a public patient.
    Like other commenters on another thread, I don’t mind the Private system per se it’s just that it’s not really private is it? Plus they continue to support ‘health care’ that is of questionable benefit at best.
    (I do have Private insurance and resent every last cent I put in to it especially as there isn’t a private hospital withiin 1000km of where i live at the moment)

  19. Sans Blog

    “In the case of a procedure for a (slow growing) malignant tumour, the wait was days.

    But that has to be diagnosed first. I recently had to have a colonoscopy – waiting time for one in the local public hospital was 12 months.

    I had it done the same week in a private hospital and several pre-cancerous polyps were removed. As I have had two cousins die from bowel cancer just two years older than I am now, that 12 month wait could mean disaster.

    I would like to see the whole private health insurance industry done away with too but not until the public health system is dramatically improved.

  20. The Intellectual Bogan

    “In the case of a procedure for a (slow growing) malignant tumour, the wait was days.”

    But that has to be diagnosed first.

    Time between 1st GP visit about the suspicious lump and confirmation of the presence of a carcinoma was less than 1 week.

    I’m merely reporting on cases in WA of which I have direct or very near direct personal experience. I’ve no idea what happens in other states or to other people.

  21. Chris

    Maybe Mrs Bogan and I are lucky in having GPs with some degree of pull in the system, or maybe WA’s waiting lists are just short.

    Knowing people who know people definitely helps. After an accident I had a really good experience with the emergency department in a public hospital but they told me I would have to wait several weeks before seeing a specialist. Luckily a good friend’s brother specialised in just the field I needed so I got in the next day. Not only did it reduce the probability of long term damage but it was also a huge psychological relief as the ED doctor wasn’t sure what the long term result was likely to be.

    I was really surprised to discover a couple of years ago that the waiting period for checkups for some types of cancer can literally be 3-4 months after it happened to my wife. Perhaps its just due to overzealous GP’s referring when its not really necessary but it means that if something is wrong its likely to be much worse when the get around to looking for it.

  22. patrickg

    Chris you may also find that’s a function of the number of specialist in any given city, rather than any private/public divide.

    Having unfortunately had to see a number of specialists in different cities, the waits were always about severity of condition + number of specialists available. I waited a loooooooooooooooong time to see a dermatologist in Canberra in 2000.

  23. bryce

    I heard a comment about the public hospital system by Michael Wooldridge (anyone remember this smarmy, self-seeking slug?) a few years ago.
    He noted that surveys of recently discharged public patients had overwhelmingly positive comments on the PHS but surveys of the public at large (on the state of the PHS) were the reverse. I think, at the time, he had an interest in making the case that the PHS was doing a great job but I still accept the argument that the public’s unfavourable perception is not justified.
    How all this came about is open to debate. But my guess is that when there’s lots of money to be made (by some) from health/hospitals shifting from public to private, then shifting public opinion in the same direction is sure to be part of the plan.

  24. Lefty E

    I’ve got no problem with Razor’s choice – seems fair enough to me. I also have no problem with him, and all the other privately insured, getting medicare benefits – since they pay tax, just the same as the rest of us.

    What I have a problem is the public ALSO funding 30% of his private insurance bill.
    Its a complete outrage! And I’ve never heard a SINGLE argument justifying this expenditure.

    Time to give that rubbish the chop!

  25. suz

    “I recently had to have a colonoscopy – waiting time for one in the local public hospital was 12 months.”
    Sans Blog, where is this? I’ve had screening (ie non-urgent) colonoscopies as a public patient in a public hospital in Sydney and my waiting time was a few months (can’t remember exactly, but certainly less than six months).
    I’m not claiming that the public system – of which I have quite a lot of experience, for myself, offspring and aged parents – is perfect and I know people who have chosen to pay rather than wait an inordinate length of time for surgery, a choice I don’t criticise them for … but surely if the doctors will make themselves available to do surgery next week if they are paid privately, there has to be a way of getting them to be available to do that surgery in the public system.

  26. suz

    “I fortunately was able to be operated on by a surgeon of my choice”. I’m glad for you. I also was operated on by a surgeon of my choice, as a public patient.
    “Choice” is a slippery concept though. I mean, how much can any of us non-medicos evaluate how good a surgeon someone is? We can only evaluate their skill at talking to us in an office.

  27. Paul Burns

    Over the past couple of years I’ve had to spend up to two months a year in hospital here in Armidale. I just take in heaps of books, pens and system cards and continue on as normal, though the whole experience can be pretty stressful especially if you’re connected up to drips and oxygen bottles and things and want to go to the loo. No matter how good the care (and I have a wonderful GP now) hospitals are still like prisons. Most of the nurses are excellent. Though there’s one or two I won’t let near me.

  28. Chris

    patrickg – yes Canberra is only 300,000 people and for its population has pretty amazing facilities. Though I have been warned in the past by medical people that if I were to get really sick its better to go to Sydney. Apparently part of the problem is with a small population doctors can lack experience.

    suz @ 24 said:

    but surely if the doctors will make themselves available to do surgery next week if they are paid privately, there has to be a way of getting them to be available to do that surgery in the public system.

    Sure, you just have to be willing to pay them. And probably more than just the medicare benefit too. There’s not a “bed shortage” just a shortage of willingness to pay for people to look after the people in the beds.

    The one thing I did really appreciate with private insurance was being able to stay in the same room as my wife at the hospital when our daughter was born. From my perspective it really helped with bonding with our baby, and I wouldn’t give up private health insurance unless the public system also allowed the same – single rooms in maternity and allowing partners to stay.

  29. suz

    Chris, my partner was able to stay the night with me in a single room as a public patient in a public hospital both before and after our baby was born. (Yes, medical drama was probably a factor in that.)

  30. Francis Xavier Holden

    sans blog – seems unduly long wait time for colonoscopy. You might be in a risk group due to family history/ symptoms – I think that should get you in in 30 days.

    You can do your own Faecal Occult blood Test (FOBT) – [no you don't need a pentangle, candles and gris-gris] . You don’t do the test yourself – you take the sample yourself and send it away. Ask your GP about it and also about the National Bowel Cancer Screening Project. The FOBT is a reliable screening test for indicating if a colonoscopy is needed.

    Colonoscopy in the private sector should be cheap – around $120 tops co-payment.

  31. Chris

    suz @ 28 – that would be great if was general policy. All of the friend’s I’ve visited in public hospitals have been in multi patient rooms so partners weren’t allowed to stay overnight. I think the partners can miss out on a lot when that happens.

    suz @ 25 – again its where knowing people in the medical profession can really help. To at least find out which doctors to avoid.

  32. Lefty E

    Jesus, who wants to “stay over”?!! Do these guys have any idea whats coming next? They gotta be first timers.

    Go out and have a few stiff drinks. In fact, get tanked. She’ll be buggered and you’ll only be giving her the shits hanging round like bad smell. The baby’s nowhere near her anyway – let her sleep!

    And as long as you turn up on time next morning, dont feel guilty either.

    Cos that’s you two f*cked for the next 6 months of sleepless hell on earth. And that’s if you’re lucky. Could be 9.

  33. Lefty E

    OH yeah, and where are all the bad news private hospital stories? Commercial-in-confidence, hush-hush settlements, thats where. Whereas public stuff-ups are – well, public.

    Cos Ive heard plenty! Anesthetists playing golf; doctor of your choice on his choice of holiday when you need it. Oh, and the public hospitals are the teaching hospitals too – so that’s where you get all the top-shelf talent.

    As it happens, we needed at anesthetist at 3am on Easter Sunday when our daughter was born. The nurses and midwife made it pretty clear we were lucky to be in a public hospital with one on staff – wouldn’t have happened for hours in a private hospital.

    Of course, you get a better room afterwards, sure. But lets not pretend the “medical quality” story is all one way.

  34. Chris

    Go out and have a few stiff drinks. In fact, get tanked. She’ll be buggered and you’ll only be giving her the shits hanging round like bad smell. The baby’s nowhere near her anyway – let her sleep!

    How long ago was this? At least in our experience thats not the way it works anymore :-) Our baby was with us the whole time we were in hospital from the moment she was born. Even with the hearing checks they don’t take your baby away – you go with them.

    Of course, you get a better room afterwards, sure. But lets not pretend the “medical quality” story is all one way.

    Its not, and if it was a high risk pregnancy we probably would have been in the public hospital. But the bonding time was important to me and it was great to be able to participate from the beginning rather than just being a visitor for the first few days.

  35. Sans Blog

    “Sans Blog, where is this [12 month wait for colonoscopy]? ”

    Nepean Hospital Penrith NSW, Suz.

  36. Helen

    LeftyE @ 32: Precisely, a lot of anti-public-hospital commentary assumes that the private system is purer than the driven snow.

    As I understand it – Experts like FX contradict me if I’m wrong here – many private hospitals don’t have doctors around the clock. So if you went into multi organ failure or something at 2 AM then bad luck.

    From personal experience, we had a paediatric dentist do a procedure on our son in a private hospital, as everyone here knows Medicare assumes the teeth are not part of the body. Go figure. Anyway, although the nurses were very nice and the Paed dentist was top notch, there was a pile of dirty linen sitting in the shared ward bathroom/toilet the whole time we were there. Not a hanging offence, but I can see how people would roll their eyes and go “how typical” if that was in a public hospital.

    Another thing that interests me is that in this country, “queue jumping” the medical system via private insurance is deemed morally sound while “queue jumping” (which is a misnomer, of course) in the immigration system is considered a crime. Perhaps people understand urgent need better when it’s their own.

  37. suz

    re 35: Mine were in Concord Hospital and nowhere near that wait.

  38. Lefty E

    2004 Chris. I dont know what hospital you were at, but Ive never heard of anyone being with the baby – all night – on the first or 2nd nights, while still in hospital – and plenty of friends have had kids since. Not common at all, Id say!

    Yep Helen, and so much private health system money funds the b*llhsit factor (ads, campaigns, all those ridiculously healthy 18 yos jumping up and down etc) – that the idea that system is more “efficient” is just plain silly, and illogical.

  39. josh lyman

    Lefty E: how weird. I’ve never heard of people having their baby taken away from them on the first few nights (unless there’s a problem and the baby is in ICU or High Dependency Unit; or for child protection reasons). I hear you on the “don’t regret getting a good night sleep for the last time” though!

    My wife and I got lucky at birth – the only maternity room available was a ‘family room’ with a double bed. Good thing though, because we were there a week thanks to bub deciding to pull the ‘not breathing’ trick on day 3 (twice) and then getting jaundiced so bad he needed treatment. I can’t speak highly enough of the nruses and all but one of the doctors we met in that time.

    At 7 weeks our baby was diagnosed with a rare liver condition that required surgery and will probably require a liver trnasplant at some point. Again, brilliant doctors and nurses, although we could do without the 6-bed baby dorm room in the recovery ward.

    That comment by Wooldridge about the disconnect between people’s direct experience of public hospitals and their sense of the public system in general is also true of public education. Again, may be because some people have an incentive to talk down the system for personal gain. It could also be because people with a good story tell 1-2 people, but people with a bad story tell up to 100 (old marketing adage).

  40. Chris

    LeftyE @ 38 – Wow I thought it was standard these days – perhaps its just an ACT thing? There was nursery for premmie babies (though the really premmie ones are transferred to the public hospital). But the norm was that the baby stayed with the mum and partner if around, the whole time (I wheeled our daughter from delivery to our room). Nurses were there 24 hours for help, advice, demonstrations etc but the expectation was the parents would start with the caring for the baby straight away.

    If I remember correctly from the antenatal classes they do it this way because they believe it works better for establishing breast feeding and bonding. And neither of us would have wanted our baby taken away to another room anyway!

  41. Sally R

    Ditto, Lefty E.

    The idea that an insurance industry can be more cost-efficient beggars belief. By its very nature, it can’t be.

  42. Francis Xavier Holden

    As I understand it – Experts like FX contradict me if I’m wrong here – many private hospitals don’t have doctors around the clock. So if you went into multi organ failure or something at 2 AM then bad luck.

    I’m no expert – “sign here and that will be a $185.90 co-payment thanks. Card is ok – no cheques”

    There’s private hospitals and private hospitals same as public. If you were in Epworth Richmond – or even Box Hill – you’d have a suite of pretty good people and an ICU available, but if you were in a smaller outer private, say, Leafywood East Burbs, then it might not be a great deal more than you’d get in a good hotel/motel with a nurse on duty and a phone number of a medico or ambulance.

    If thinsg go really pear shaped then for me I always reckon the best place to be is either in the back of an ambulance going somewhere big, tertiary, teaching and busy or on a trolley in ED somewhere big, tertiary, teaching and busy.

    Less pear shaped issues like the broken leg, arm etc then if you can afford it, shell out the $200+ and find a less busy private ED, like Freemasons in East Melb and you’ll be in and fixed by good people in two shakes of a dead lamb’s tail.

    Other wise with ED try not to have an accident or emergency that gets you to Western Footscary/ Sunshine at around 11pm on a Saturday night. Tuesday night around 2 am is good to aim for – not many drunks, car accidents etc around .

  43. FDB

    LE:

    “where are all the bad news private hospital stories?”

    I had appendicitis as a 16y.o. (still on the family private cover), and sat in a waiting room in searing pain for 2 1/2 hours before a doctor saw me. Sticks his fingers up me jacksy and says ‘cripes, we’d better get this out pronto!’.

    Yeah, I winced. No shit.

    They were very clearly not busy, beds maybe half occupied by the time I got to the ward.

  44. Francis Xavier Holden

    suz @ 24 :

    but surely if the doctors will make themselves available to do surgery next week if they are paid privately, there has to be a way of getting them to be available to do that surgery in the public system.

    Yes just pay them (and associated costs, nursing , theatres etc). And many, if not most, will and do work in the public system for far less than they get in private.

    A lot of “private” work occurs in the public system, depending on the place it can be up to 70% public – 30% private. In general private surgery in public hospitals does not crowd out or impinge on public surgery. That is, in essence, private lists in public hospitals utilise, and pay for, idle theatre time and associated staffing etc.

    Public hospitals are limited in the amount of public surgery they can do. The limits are financial, they are only paid to do so much.

    Theatre time can be in theory used 24/7 (say 20/6 to allow for cleaning maintenence). If people are paid appropriately than they will work some of those hours. However there is a limit to how many hours a day/week/month/year people will work, even when paid handsomely, so there is a limit to how far this can be pushed with a scarce workforce.

    However- even if squillions of $ were to be thrown at waiting lists – there would still be waiting lists and people would still have to be prioritised on the basis of acuity and other criteria.

  45. Chris

    josh @ 39

    It could also be because people with a good story tell 1-2 people, but people with a bad story tell up to 100 (old marketing adage).

    And its the bad experiences which stick in our mind too. 99% of our dealings with our bank have been fine – helpful and we get the service we expect. But its the stories of the 1% of the time when they stuff up that we tell other people about.

    As I said previously I’ve had very good experiences in emergency – generally responded to very quickly but what I remember most prominently is the guy who was wandering around the emergency waiting room with a razor blade occasionally slashing his own face. He kept asking for help (and from a lay point of view pretty obviously needed it) but kept being told he’d have to wait until the morning when the appropriate team (can’t remember the name) came in.

  46. Helen

    Other wise with ED try not to have an accident or emergency that gets you to Western Footscary/ Sunshine at around 11pm on a Saturday night

    It was Footscary and it was a Saturday night – we were there about 6 pm to midnight. Miraculously, it was a very slow Saturday night there. There was one aggressive drunk- fortunately he arrived just before we were discharged.

  47. Sans Blog

    Helen @ “As I understand it – Experts like FX contradict me if I’m wrong here – many private hospitals don’t have doctors around the clock. So if you went into multi organ failure or something at 2 AM then bad luck.”

    I had an operation, with a mortality rate of 1 in a 100 with 30 days of the op , in a private hospital in 2001 . I had no idea at the time that there were no resident doctors or resuc team on duty after hours. Apart from my surgeon’s visit, the only doctor was a GP who came in after breakfast each day. Two night duty nurses for the floor of many private rooms was it. The private hospital is next to the public one and I know now why there’s this long ramp running between the two and I’m glad I didn’t have to make use of it.

    I would never have had the op there if I had known.

  48. Fine

    As a friend once told me who’s a senior nurse, if you’ve really got something wrong with you, go to a large, public teaching hospital.

  49. Lefty E

    Yeah, I once visited my aunt (who has private insurance) after an op. The thing that struck me – I could have shot a bazooka down every hallway and no trained medical staff of any stripe would have suffered injuries.

    There was no one there! It was like a motel.

  50. Chris

    There was no one there! It was like a motel.

    And thats probably ok under some circumstances. Eg for births where everything is ok some private funds after a day or 2 will put you in a nice hotel for a few days rather than keep you in hospital the whole time. There’s a midwife/nurse available 24/7 if you need help which is the main advantage of being in hospital with a newborn.

    I wonder how many beds in hospitals they could free up if there was better in-home care available.

  51. laura

    I have no private health insurance but I’m going through a process of rigmarolish medical interventions which are being managed by a specialist who I’m seeing privately. A lot of the procedures she is ordering are being funded by Medicare but not all; it’s all part of the same condition from my end, but the Medicare schedule treats them differently.

    This blurring of public / private extended very precisely to day surgery I had a month or so ago. It was performed in a private (Catholic) hospital but I was a public patient. Really I’m a bit buggered to know how that works, but that’s what it was.

  52. Francis Xavier Holden

    laura was it Mercy@Austin? Part of it is funded, as was the old Mercy in East Melb, as a public hospital for women. Mercy Health also runs the public hospital at Werribee.

  53. laura

    Yes it was FX.

  54. Lefty E

    “… the old Mercy in East Melb” The very site of my tales, above. Great hospital – nothing but positives to report.

    Ms LE was also, somheow, a public patient at the same Catholic hospital Laura. We never really worked that out.

  55. Francis Xavier Holden

    lefty e – it’s public hospital run by Mercy for the state – there’s nothing much to work out. A different set of Micks – Sisters of Charity – run another of Melbourne’s great public hospitals – St Vs.

  56. Lefty E

    Gotya FXH – So, not some weird public/ private mix so much as a straight public hospital, run by Rome-followers, Croppies, Taigs and Papists – for the Crown, as it were.

    Ot did I just complicate matters further with unnecessary stereotyping :) I’ll use the “I wuz baptised one so I can” loophole.

    Good hospital anyhoo.

  57. Chris

    LeftyE @ 56 – sometimes its a mix of public/private. For example the emergency department (the only one on the north side as far as I know) in one of the private hospitals in Canberra is “public” and patients going into emergency there are funded by the government. But otherwise its a private hospital. Run by the Catholics too I believe.

    I guess its a bit of the Medicare Gold strategy which Gillard once pushed – direct government payments for patients to go to private hospitals.

  58. Eddy's mum

    No, it’s nothing to do with Medicare Gold. It is fairly common around Australia – catholic hospitals with good reputations run as public hospitals. I always understood that it came about when the church lost its cheap labour force (ie fewer nuns) and healthcare got more technical (ie more skilled workforce needed).

    Our experience of public health care has always been largely positive. When we’ve decided not to wait we’ve chosen to pay as a private patient in a public hospital. We’re still way ahead by not paying private health insurance premiums. I’d suggest that the “choice” is often not as great as it is painted.

  59. Chris

    Eddy’s mum @ 58 – I wasn’t saying it was Medicare gold exactly, just in the case of the hospital in Canberra it really is a mix of private and public, not a public hospital run by the Catholics. I believe the same Catholic group also own and run the fully private hospital on the southside too.

    We’re still way ahead by not paying private health insurance premiums.

    That however is true in most cases where people decide not to get insurance. I’m way behind for paying for car insurance, though I’m a bit ahead on contents insurance after a big burglary a few years ago. I guess the difference with healthcare is that you don’t need to worry about absolutely catastrophic events as the public system will kick in and generally speaking do a very good job.

    Its the middle ground where the surgery is deemed elective with a long waiting list and for whatever reason you don’t have the money to pay for it privately. And unfortunately I think its becoming more common where private specialists refuse to take on patients without private insurance in case there are complications and there is a cost blow-out.

  60. Francis Xavier Holden

    Lefty – to add to your confusion – Public hospitals in Victoria also take private patients.

    Epworth Richmond (and St John of Gods Ballarat used to be – not sure now) is also accredited to take time-critical ED public admits by ambulance.

  61. Dave

    Some people seem to be under the delusion that people who are using the private system are somehow saving the government lots of money. The reality is that apart from the 30% Private Health Insurance, when people use the private system the government is paying a large % (through Medicare) of the doctor’s fee. The government gives 75% of the doctor’s schedule fee.

    75% of a surgeon’s schedule fee, when averaged per hour of private time, is substantially more than a surgeon’s hourly wage in a public hospital. Which means that one of the main beneficiaries of patients using the private system is doctors, not the government.

  62. suz

    Thinking about waiting times for hospital tests, eg colonoscopies, I’m wondering if the wait is long if you approach via outpatients, whereas the wait is shorter if you approach via a consultation with the specialist in her/his rooms. Money is obviously a factor in that, as you have to pay for the doctor visit. But having a direct relationship with the specialist, even if you haven’t got private health insurance, seems to get you in faster.

    Sydney also has at least one private/public Catholic hospital – St Vincents, which has an Emergency department. The x-ray/ultrasound clinic where I had my bulk-billed test is associated with St Vincents. I was chatting to the technician and found out that they don’t do any ultrasound for IVF there, as of course they don’t do IVF or terminations (so they also rarely do amniocentesis.) So on that score, it’s a funny sort of public hospital (though I’m not bagging that hospital, I have friends who’ve been patients there and received excellent treatment. And they’ve been the main centre for HIV in Sydney.)

  63. Francis Xavier Holden

    In public health the wait list is decided by the hospital on a first in best dressed – taking into account acuity assessed by surgeon. It won’t make any difference how you enter the system.

    suz – you’ll also find a dearth of research facilities using stemcell in the catholic places.

  64. patrickg

    Not to mention various policies on abortion FXH.

  65. Chef

    Yes, public hospitals run by Catholic administration is a definite worry, as they’ve come out against the decriminalisatiopn of abortion. They’ll also refuse to provide contraception and emergency contraception.

  66. Lefty E

    Ah, yes, meant to say: the only part of the regular pregnancy medical routine the Mercy wouldn’t do was the 12 or 18 (I forget) week Downs syndrome test scan.

    We had to go to the Epworth for that.

    Its a Catholic thing.

  67. Lefty E

    This is compulsory reading on these issues. The so-called ‘safety net’ is being rorted by the well-off, and has got to go – if it hadnt been introduced by the govt of the day you’d call it extortion, and charge certain doctors with receiving stolen goods.

    Just another example of the Howard govt sneaky campaign to undermine public hospitals, and funnel taxpayers money to the wealthy.

    IN THE BIN! http://www.theage.com.au/opinion/welfare-for-the-rich-makes-for-a-sick-system-20090429-and1.html

  68. Chris

    LeftyE – I wonder if the better way to do the safety net is to instead of having a fixed threshold make it a percentage of household income. Its generally hard to find a bulk billing doctor and those that do will only do so if you’re on a pension of some kind.

  69. Lefty E

    Or means-test it, Chris. At the moment its skewed towards higher income people who can reach the threshold – as the article says 75% of the safety net expenditure is on high incokme groups.

  70. josh lyman

    I’ve always wondered about Catholic public hospitals. Public, that is, in every way except that certain medical procedures will not be performed (and usually, not even advertised as existing) because they offend Catholic doctrine.

    I have no objections to a private Catholic hospital enforcing their own doctrine (indeed, I’d be disappointed if they didn’t), but why should the public not receive a service just because their nearest hospital/only hospital is run by a religious order?

    This obviously came to a head last year in Vic over abortion but its nationwide and not limited to that topic. (BTW does anyone have an update on the threat of mass civil disobedience by Catholic doctors on the referral issue?)

    I also don’t get why religious welfare NGOs running 100% public funded programs get to discriminate on religious grounds.

    Coming from the other angle, it’s amazing how non-religious many “religious” NGOs are these days, esp. at senior management level. Try telling some finance and HR managers they are working for the church and they look at you like you have smallpox.

  71. Francis Xavier Holden

    I don’t see the catholic /public hospitals as a big deal. They don’t do terminations and amniocentesis or IVF but then a lot of other large public hospitals don’t do IVF or other procedures – not through moral objections but lack of staff for facilities or they just don’t want to do them.

    LeftyE -I’m not sure but I suspect a great deal of the rich suburbs getting the threshold on MBS is due to private births/obs/gyny now charging the fullfee as an upfront consult, subsequently covering all in hospital and post inpatient treatment, thus triggering the threshold on first consult, so patients have no other out of pockets other than that first $800. Motherhood – we are all for it.

    Some of it might be hip replacement and stuff.

    Be interesting to get a better analysis than The AGE’s handwaving. It seems these days newspapers don’t do any real analysis or nuanced in depth understanding. It’s all Bolt/Deveny type stuff left or right or beige.

    Getting rid of the private insurance rebate will be good for everyone’s health

  72. Nabakov

    My only persinal experince with Australia’s public health system was having my wisdon teeth removed at the old Royal Melbourne Dental Hospital – which interior designwise did not seem have tochanged since Prince Albert was cocky Saxon pup.

    Cheerful young dental surgeon: This is gonna take a while. Local or general?
    Me:That’s a Models’ Album.
    Cheerful young dental surgeon: And not as good as Two Cars To The Toucan. General it is.

    I woke up an hour or so later with my mouth throbbing but the gum gnawing wisdom teeth gone forever and a cheerful nurse saying I could lie in the bed for another hour so but really they did need it back soon, my girlfriend was waiting downstairs to take me home and here’s a bottle of super-asprin for the pain. If it doesn’t go away after a few days, come back.

    Total cost: One nice dinner for the girlfriend who drove me home afterwards and then counted my remaining teeth with her tongue.

  73. Nabakov

    However, as evidenced by the comment above, my encounter with Australia’s Public Blog Spelling System is not a good example of a safety net in action.

  74. Nabakov

    “Two Cars To The Toucan.”

    Doh!

    Two Cabs To The Toucan.

    I’m not losing my memory, rather the past is not keeping me updated about its movements.

    Anyway off tomorrow night to see the Laughing Clowns. Last time I saw then was 25 years ago. Time used be a thief now it’s a neo-rentier.

  75. suz

    “LeftyE -I’m not sure but I suspect a great deal of the rich suburbs getting the threshold on MBS is due to private births/obs/gyny now charging the fullfee as an upfront consult, subsequently covering all in hospital and post inpatient treatment, thus triggering the threshold on first consult, so patients have no other out of pockets other than that first $800. Motherhood – we are all for it.

    Some of it might be hip replacement and stuff.”

    Yet just yesterday I read an analysis of number of births per Sydney suburb which showed that the richer suburbs are producing lower numbers of babies!

    I’d tend to agree with Davidson that the safety net is being triggered by middle class people going to specialists rather than to hospital outpatients. And having lots of minor day procedures in private hospitals – the surgeon’s and anaesthetist’s fees still contribute to the safety net amount in that case.

  76. Francis Xavier Holden

    suz – i’m not really disagreeing with you except to say I’ll bet it can be tracked down to a few bigger spend items/procedures.

  77. Sam

    suz

    I spent four days in a public hospital last year. Like you, I was admitted extremely quickly after my intitial consultation with my GP – ten days, including seeing a specialist. I did not pay one cent, except unlike you I balked a bit at the food. It was perfectly reasonable, but when the doctor says it’s OK for your friends and family to bring reserves from outside, who could say “no”? During that four days, for two of them I shared with one other person, and for the other two with two other people.

    I cannot see what all the fuss is about. Our (NSW anyway) public health system is senstational

  78. Chris

    LeftyE -I’m not sure but I suspect a great deal of the rich suburbs getting the threshold on MBS is due to private births/obs/gyny now charging the fullfee as an upfront consult, subsequently covering all in hospital and post inpatient treatment, thus triggering the threshold on first consult, so patients have no other out of pockets other than that first $800. Motherhood – we are all for it.

    Actually I believe the threshold is about $1100 for families and you still have out of pocket expenses. After the safety net threshold you still pay 20% of the out of pocket expenses. Still can add up to quite considerable savings though. It probably acts as a sort of private insurance subsidy as instead of the health funds having to cover obs fees the government covers part of it.

  79. Chis

    suz @ 75

    Yet just yesterday I read an analysis of number of births per Sydney suburb which showed that the richer suburbs are producing lower numbers of babies!

    If they didn’t do any other adjustments that would not be surprising at all as the richer suburbs are going to have a higher percentage over older people and a lower percentage of people trying to having children. Though maybe a higher percentage of people trying IVF which would push the safety net stats up even further given how expensive it is.

  80. Caroline

    Well I think you’ve already given away the vital information suz, it was Concord? As I was reading your experience, I couldn’t help thinking that you definitely weren’t describing the once great but now just gideous RNSH. Which is my point: public or private, hospitals are like the five fingers on my hand. Every one is different and all are slightly bent. No, no, no I don’t mean that. (I don’t think.)

    I too have had only good experiences in the public system, but I was treated very snootily in the private system once because I was paying out of my own dough and had no insurance. I verily glowered at the insensitivity of the anaesthetist whose only concern pre-op was how exactly was I going to pay? Once he had me on the wheelie tray, semi-conscious, completely at his mercy and very vulnerable, my angelic host must have socked it to his conscience and he came over all sweet and hand-holding–his kindness made me weep and then I was gone.

    I’d go the public everytime but of course it depends on which one.

    I hope you’re well on the way to full recovery suz, and Josh @39 I hope the little tacker is doing ok. That’s a tough ‘welcome to the world’– such as it is.

  81. Mercurius

    Well, my experience is now out-of-date, but in the mid-1990s the RNSH did an amazing job putting my leg back together after a motor-bike accident. Life-threatening injury, they not only saved my life but my leg too. Then I was in a single room for a week until recovered enough to join a multi-person ward. Then a few more weeks of intensive physio until discharged, with lots of out-patient care provided to get me walking properly again. Not a cent out of pocket except for the refundable deposit on the crutches! Did the Sydney half-marathon a few years after the doctor told me I’d never be able to run again.

    Although would be happy to never again smell a hospital cafeteria! :)

  82. Mercurius

    Meanwhile, from 2007, here’s a good comparison of public v. private with the same patient, 4 weeks apart…

    At Prince of Wales Randwick, had a family member publicly admitted for emergency diagnostics after a health scare. Discharged 4 days later after checks came back OK. The diagnostician happened to be the *same doctor* we’d been seeing as private patients, but cost us nothing to see him in the public hospital! At any rate, we booked a private “elective” (“elective” in the sense that you can elect to have the operation, or elect to be in crippling pain for the rest of your life) procedure with him a month later, since it was the only way to get him as the surgeon. Not a cent paid for the public admission.

    4 weeks later, go back this time for the private admission. Our insurance “paid” for the hospital bed (in the same ward as we’d been in the public admission 4 weeks earlier!) and about 20% of the surgeon’s fees. Medicare paid 30% of the surgeon’s fees. We were then out of pocket nearly $2000 after paying thousands of dollars of “insurance” premiums for years beforehand.

    Canceled private insurance the following week. I wish there were a hell they could all burn in.

  83. Chef

    Mercurius
    Just to clarify, would he/she have had the procedure if you hadn’t had private insurance?

    Would it just have been a case of “bad luck, elective surgery, suffer” or would he/she had it but with a different surgeon?

    My H has taken out private insurane specifically to have a hip replacement, so I’m interested in this scenario.

  84. Helen

    D’oh! Why does that silly nym, adopted once as a silly joke about teabagging and salty balls, keep coming back to haunt me? Good home cook I am, chef I am not! As you were…

  85. Mercurius

    Chef – I don’t know. There are no good options, only less worse ones. The procedure might not have been available publicly for a long time, if at all. OTOH, since it was ineffective anyway, the point is moot. (Or, in other words, public systems only fund procedures with a high likelihood of effectiveness. Private systems will trade off people’s hope of a cure, no matter how forlorn the hope or how ineffective the results. Hence inefficiencies creep in and a lot of money is spent for no good outcome…)

    We just paid a lot of money for a procedure that didn’t work. That’s life. But what floors me is that, our “insurance” covered less of the surgeon’s fees than did the Medicare payment for the same procedure! And it “paid” for a hospital bed my relative had been in the previous month as a public patient anyway…

  86. Francis Xavier Holden

    aah – told ya – see my comments above re obs/gyny and safety net and then read this:

    Since the advent of the safety net, fees have leapt by 290% for IVF and 40% for obstetrics – giving rise to claims that the system is being rorted.

    .. the crackdown ….. – is expected to save $437 million over four years.

    Areas targeted for cuts include artificial reproductive technology (IVF), obstetrics and varicose vein treatment, identified in a report into the scheme.

    http://www.theage.com.au/national/crackdown-on-doctor-rorts-20090506-avc2.html