Does Private Care Cost Too Much?

Private health care is not currently well regarded in some sectors of the community. This is resulting in an increasing number of people dropping their private health insurance (PHI). At least part of the reason for this appears to be the concern regarding a real or perceived lack of value.

In certain, recently well described, instances this seems to be true, with huge gap payments charged to patients, and it is these stories that give private health care a bad reputation. There are, however, many private health practitioners who I think do offer good value.

For any meaningful discussion on this issue, it must be appreciated that health care is very expensive, and costs continue to increase. It should also be recognised that Medicare repayments for services rendered to medical practitioners have fallen significantly behind inflation for at least the last 10 years, whilst the costs of running a practice have continued to rise with inflation.

I can only really comment from a point of view of obstetrics and gynaecology. I am one of several gynaecologists who do not charge a gap payment for gynaecological procedures. Most of my regular anaesthetists also do not charge a gap. There are some gynaecologists who do charge a gap, and they may well feel that they can justify that. Patients do therefore have a choice; to choose a gynaecologist who charges a gap, or one that doesn’t. There is an urban myth, (or perhaps there’s a myth that there is a myth!), that patients believe the larger the gap the better the practitioner. This is not true. The mere fact that a specialist charges a gap does not suggest that they are a better specialist. In some circumstances, a sub-specialist for instance, the practitioner may have undertaken additional training, but generally there is no direct correlation between the charge and the service.

I do not charge a gap for any gynaecological procedure, whether at a private or a public hospital. I am therefore occasionally surprised when a patient asks, at the end of a consultation, “how much is that going to cost?”. To be fair, there may be a number of costs that are not under the practitioners' direct control, such an pathology fees, or a gap payment to the anaesthetist. There does however appear to be some misunderstanding regarding the system, and what is offered by different practitioners. That in its self is not actually surprising; the health care system is generally quite complex and far from easy to understand.

Obstetricians in Perth generally tend not to charge a gap. However, all charge a pregnancy management fee (PMF), which could be regarded as a gap payment. This fee was introduced to cover the extremely large indemnity costs that specialist obstetricians are required to pay, and to cover the fact that obstetricians are required, in a very real sense, to be on-call for their patients 24 hours a day, 356 days of the year. Of course, then are times when an obstetrician will not be available, in which case a colleague will be available, but on a day to day basis, your obstetrician is very likely to be there for you. I believe the fee is fair, particularly bearing in mind the personal cost to an obstetrician and their families; the missed family opportunities are too numerous to mention; family dinners interrupted, childrens’ bed times missed, grumpy wives (or husbands)! to name but a few, not to mention lost sleep!. Medicare originally paid the entirety of this fee, but only a proportion is now paid by Medicare. A small number of east coast obstetricians charged an obscene fee, and this was no doubt seen by the government as an untenable situation.

Most obstetricians in Perth charge a PMF of between $2000-4000. That may seem like, and is, a large sum, but if you consider the care and dedication offered by your obstetrician, I think that this represents good value for money. You are cared for by a trained specialist of your choosing, with whom you have developed a special and often unique and long-lasting relationship, whom for the most part is available to you at all times, in the pleasant surroundings of a private hospital. Alternatively, you could wait until you’ve had two babies in the public system, and then buy yourself a basic QLED TV with the money you’ve saved. I don’t mean to sound trite; that is still a substantial sum, but the peace of mind and level of expertise that you expect to receive, by having your obstetrician available at a private hospital, is likely to be worth that outlay.

The relative outcome of pregnancy and delivery can never be guaranteed, and there are always potential risks in having a baby. Having a fully trained, experienced specialist will improve your chances of a good outcome, and having a familiar face that you trust cannot be over-estimated.

Just as an aside to that, it’s interesting to look back at statistics from the past, to put the whole having a baby thing in perspective. Nowadays, we expect good outcomes from all aspects of medicine. We no longer expect our children to be deafened (or to die) from measles, or to be disabled by polio. These things still happen, but rarely, thanks to vaccinations. And we certainly don’t expect mothers to die in childbirth. Luckily, very few do, and that’s due to a whole host of improvements in medical care, including good obstetric practices. However, that was not always the case; as recently as the 1930s, (ok 1930 isn’t exactly ‘recent’, but it’s not like the dark ages,), one in every 150 women died from pregnancy (1 in 30 babies died in childbirth back then). That figure improved to 1 woman in every 2000 by the 1950s. Nowadays, In Australia, we would expect about 1 in 10000 mums to die. Thankfully we don’t see it very often, but it still happens.

Back to the point; I think it would not be unreasonable for specialists to publish their fees, so that patients could more easily choose a specialist whilst being aware of the costs, if they wish to do so.


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