Public hospital - private patient question

[dazzler]

Wondering on peoples thoughts on this.

Last wednesday my 5yo dislocated and fractured her elbow and ended up in A and E here in Hobart.  She had sheared the bone in two and one piece was up towards her bicep.  (there is no private hospital that A and E's children down here so public it was)

We had been in A and E for about 4hrs when the registrar saw us and said she saw that we had private health insurance and would we like to go as a private patient.  I asked if there were any benefits to using it to which she replied 'no'.  I politely said 'no thanks'.

She was scheduled for emergency surgery that night.  That got bumped to the next morning which got bumped to lunch which ended up at 4pm.  26hrs after the injury.

About 2hrs before she finally got in for surgery another registrar came and repeated the same will you come in as a private patient.  She explained that by doing this my insurance company would pay all costs and the hospital would pay the excess.  This helped the hospital with funding.  By this time I was less tolerant given how long my little one had been in serious pain and told them no and dont ask again.

What peaved me is that we only have private health because if we dont then we have to pay an additional levy on our tax (classic middle income family).  We both pay our income tax and obviously GST on goods we buy so we pay our fair share so to speak.  For anything elective we go private and pay our excess leaving the pubic system alone as best we can.

Now my private health insurance is a business and it bases its premiums on its outgoings.  Therefore, the more costs to the insurer the more the premiums will go up. 

Im now not sure whether I did the right thing or not.  Our hospital system down here is pretty well stuffed so using it would have helped, but is that the right thing to do, or for the govt to expect to be done.  If they cant run the hospital properly, and by any stretch 26hrs for a child to wait for emergency surgery is stretching acceptance, then they should get someone that can.

The nurses and doctors were wonderful and were really caring which was great.  They were even polite to the bogans that treated them like crap.  Dont know how they do it.

Should I have used my private health?

cheers

[shrek4]

No or yes... It depends.

Staying at the public hospital I would have gone with the public too as you would've had little difference in treatment etc saving for the 'gap' excess from your private health.

That said once A&E assessed your child it should have been possible to transfer to a private hospital for the surgery to occur. This may have had them seen to sooner.

[Mace]

Agree with Shrek,

Surgery schedules with specialists are probably  predetermined for the following day/s. Probably made little or no difference in operation timing IMO.  Being a private patient may have bumped you up a few places, but surgeons still deal with "life threatening" or critical patients first.

Hope the recovery is going well.

 

[lilstookie]

Can't answer your question specifically but know that having a baby with PHI can cost you several thousand. I struggle with paying for insurance and having 'elective' things cost a bomb with no/little benefit

Lil


Sent from my iPhone using Tapatalk

[Teabag]

IMO, I pay it, I'll use it everytime. Whether its quicker or not. They ripp us off with it, I want to get some use or value out of it........Private Health in this country is a joke.....IMO.

[Jason B]

I have been faced with a similar question when I got a blood clot in my lung. I initially said no and was admitted as a public patient and put in a ward with 3 others (care was great). When the surgeon/specialist came around he explained to me that I had better options as a private patient, and that the Hospital would pay my excess. There would be no out of pocket for me.

He also explained that this would benefit the hospital, and that I could choose my surgeon/specialist (Him) if I was private where if I was public I would be assisgned whoever was on duty each day. I accepted and within 10 minutes was rolled accross the hallway and placed in a private room, with telly, paper etc.

I never recieved a bill and all of my med's were paid for by my fund (We are not on the top cover). As a result of this recently when our 3 year old was sick, and they asked me at the Hospital, I asked them some direct questions and again as a result of the answers we went with private. We got to see a doctor and got a bed pretty quick.

I only have health cover because I feel I should and I considered it pretty useless and a waste of $3k a year, but these two experiences have opened my eyes a bit and when its suitable I won't hesitate to use it. I was in for 6 days with my blood clot and saw every specialist under the sun, I reckon I used up at least the last 5 years of premiums in treatment in that one incident.


Regards

Jas

[jeeps]

I have full private cover. When I snapped my wrist in November i went to the mater private where emergency set my wrist. I then had to wait 10 days for surgery to get my titanium plates and bone graft as the surgeon was booked out. After surgery I stayed overnight (I was far too wasted to go home) in a shared room with 3 other guys. Total out of pocket was about $1500 including x-rays, surgery, emergency admittance fee etc.

Thinking about it, I could have had the same or better care from a public hospital. But 7 weeks after surgery I was given the all clear to get back on the motorbike, kinda... And I have full movement with little to no discomfort.

I don't know how it would have been with the public system but these are my experiences with the private system. I won't go back to public emergency rooms after previous issues.

Cheers

[Jason B]

I have full private cover. When I snapped my wrist in November i went to the mater private where emergency set my wrist. I then had to wait 10 days for surgery to get my titanium plates and bone graft as the surgeon was booked out. After surgery I stayed overnight (I was far too wasted to go home) in a shared room with 3 other guys. Total out of pocket was about $1500 including x-rays, surgery, emergency admittance fee etc.

Thinking about it, I could have had the same or better care from a public hospital. But 7 weeks after surgery I was given the all clear to get back on the motorbike, kinda... And I have full movement with little to no discomfort.

I don't know how it would have been with the public system but these are my experiences with the private system. I won't go back to public emergency rooms after previous issues.

Cheers

With A & E i usually always just go to the public hospital. However I had an experience last year that opened my eyes. Our 3 year old was sick (Temps 40 + that wouldn't come down), we were in Sydney so went to Blacktown Hospital. It was christmas Day. We got there at about 11.30pm and waited until 4am, and still didn't get seen, we left  after being told that it was unlikely we would get to see anyone for another 2 to 3 hours.

We took her home battled on with panadol and her temps continued 40+. I rang a mate who was our old family Dr and he said she's sick and needs to go to hospital. He sugested we go to NorWest Private, but he said it would cost you.........sick child.......cost ........who cares.

So we went to NorWest it cost $200 up front at the counter before they would see you. We paid and within 5 minutes of sitting in the waiting room we were in to see a doctor, private room etc. The care and efficiency was great, she was admitted straight away and put on an anto-biotic drip etc. I soon forgot about the $200 and their were no additional costs.

I have no issues with Public Hospitals and am prepared to wait a reasonable time etc but this opened my eyes and I will keep it in the back of my mind for next time (Hopefully not)


Regards


Jas

[BigJules]

I've had a couple of experiences in this area. Had our first child at a major Sydney public hospital, as we didn't have abstetric cover at the time. As two working professionals we must have looked different from the majority of patients who came through, and we were so impressed with the lovely private room we were given. Carpet, a couple of comfy chairs, a TV. Nice! Then half a day later one of the nurses asked if we were private patients? No. Oh. We were then moved to the four share rooms that can be hosed out, where we shared with several couples with no English (not that this was an issue for us) and tons of relo's  .

I have used my private cover quite a few times, been glad of it then even though I feel I've already paid my share.

So we went to NorWest it cost $200 up front at the counter before they would see you. We paid and within 5 minutes of sitting in the waiting room we were in to see a doctor, private room etc. The care and efficiency was great, she was admitted straight away and put on an anto-biotic drip etc. I soon forgot about the $200 and their were no additional costs.

My sister-in-law works at that A&E, remarkable how busy it is.

[db]

I'm an ex nurse, ex hospital business manager and current patient billing consultant implementing billing software in public hospitals.  Lots of public hospitals are now encouraging using your private cover.  It does benefit the hospital finances, and depending on where you are, the state government funding to the hospital may even include a notional value for private cover (i.e. they discount the funding to the hospital by the value of the expected private insurance use).  Most public hospitals will waive excess and if they are set up properly to do simplified billing will manage all the doctor accounts etc for you.  Sticking point for most hospitals is how the doctors behave with their billing.  The hospital can't compel them to only bill the scheduled fee, so if the doctor wants to bill over the scheduled fee you could end up with a gap payment.  So the only question I would ask is if the doctor charges scheduled fee and will I get a gap.  99% of the time the answer will be no. 

The cost to the health fund for you in a public hospital is considerably less than what they would pay in a private hospital.  For example, in a public hospital in NSW, the hospital can't charge the health fund any more for a bed in ICU than for a normal surgical bed - this is a free kick to the health fund of around $1500 / day.  At the end of the day, private health funds are one of the most heavily subsidised industries in this country - not too many others are getting a 30% subsidy.  Since most of the time people in hospital are there for medically required care, if you are paying for health insurance then it is entirely reasonable that you use your cover.

My $0.02 

 

[MDS69]

To Dazzler in the original post, mate I have no idea if you should have used it or not. I am in the same boat and don't have a clue.

We pay a shed load for private health insurance and with it going up all the time sometimes I wonder if it is worth it. I don't want to take the risk and canel it to find out.

My experiences with private health insurance have been
Wife had child #1 in Westmead Hospital (public) as a private patient with our own obstetrician. You walk into the maternity ward and turn left (for private patients) at the nurse station down a carpeted hallway with paintings/art on the wall with a nice(ish) single room. Turn right (for public patients) at the nurse station down a lino tiled hallway with dog eared posters and a shared room.

Child #2 was at Norwest private with a maternity room like a hotel suite, same for the birthing suite.

I don't recall being out of pocket any substantial amounts of cash apart from our own obstetrician.

Another time we took child #2 to the local doctor with croup. After a shot of adrenilan an ambulance was called and straight to Westmead Childrens Hospital. Another shot of adrenilan in the ambo and straight into a bed in A&E. No waiting. Released after about 6 hours partly because he had improved and partly because there was no bed in a ward available.
Ambo cost $0 because of private health insurance although in NSW you can have just ambulance cover.

I think in other states it is part of your vehicle rego or something isn't it.

If we were around home and one of the kids broke a limb or something I think we would go straight to Norwest Private as it is about 4km as the crow flies.

I think private health insurance is good for basics like minor dental and prescription specs and elective surgery but I believe their could still be a gap for elective surgery but the waiting time is cut down and choice of doctor/specialist is yours.

[BigJules]

Wife had child #1 in Westmead Hospital (public) as a private patient with our own obstetrician. You walk into the maternity ward and turn left (for private patients) at the nurse station down a carpeted hallway with paintings/art on the wall with a nice(ish) single room. Turn right (for public patients) at the nurse station down a lino tiled hallway with dog eared posters and a shared room.

Child #2 was at Norwest private with a maternity room like a hotel suite, same for the birthing suite.

Yep  .

Dazzler, I meant to say in my earlier post, I hope your little girl is recovering well. Sounds like a nasty injury.

[dazzler]

thanks all for your comments and thoughts.  Yeah it was an amazing injury and we were stumped as to how it happened as the only explanation from kindy kids was she fell down (some stairs) we think.  Anyway, when she got out we took her back to school to say hello and to see the kids and to 'get back on the horse' so to speak.

Then one of the parents asked if she would be climbing any trees soon?.  Interesting!. Then she spoke with her godbrother (the son of her godparents) whom she is close and we overheard her say that she was climbing a tree in the playground and jumped from that tree to another but only got to get her fingertips to the branch, swung upside down and plummeted to earth hitting a wooden step on her way down.      This explains the impact - a bit like falling off double bunks.

She will be back in hospital in 2 weeks to have the cast removed and the wound checked, an xray to check the bones are aligned correctly and if so its another cast for six weeks then back in to have the wires removed.  Amazingly the little trooper only had panadol for the pain when it first happened and from then on refused to have any even though she was in pain. Dont think I could have done that 

Thanks db for the explanation from the coalface.  I think I was a bit hung up on the principal of the whole thing and why the govt cant run the damn thing properly but that is probably a larger issue with the crap state govt(s) that we have down here. 

cheers all.

[db]

Glad to hear your daughter is doing well and hope its all smooth sailing with the cast etc.

Couple of things to consider in relation to private health insurance.  Its great to say you have your choice of doctor, but how many of us really know who is good and who isn't.  If I was still in Victoria, where I used to work clinically I could find out, but here in SA, where I have never worked as a nurse I'd have no idea.  We generally rely on the recommendation of our GP, who may have lots of reasons to recommend someone. 

Your choice of private hospital is dictated to some extent by the hospitals that the doctor works at - they don't have admitting rights at every private hospital.  Private hospitals don't really consider their clients to be you (the patient), they spend most of their effort attracting the doctors (who then bring in the patients). 

If you are seriously ill you will quite likely need at least some care in a public hospital, only the very biggest private hospitals can do the really complex stuff, and there are some things that they just don't do.  If you are elderly with complex medical problems you will probably be in a public hospital, private hospitals try to minimise looking after complex medical patients, its too hard to make money on them (and even the not for profit private hospitals still have to make money - they should be called 'not for distribution to shareholders' because they still have to make money).

If you are in smaller private hospital and have a medical emergency (like a cardiac arrest) they will call an ambulance and ship you off to the nearest public A&E.  I used to be a unit manager in small private hospital and that is exactly what we had to do on several occasions.

Very few private hospitals have kids wards.

Don't get me wrong, you get very good care in private hospitals, the nurses, doctors and other health staff all came through the same universities.  But there are differences in the two systems that mean that they are not always interchangeable.

Basically the funding model for private and public care is totally broken, the ones doing the best are the private health funds (private health insurance industry made about $1.6 billion profit last year). 

[Wandering Tassie]

Hi Dazzler, sounds like she is a tough little girl. Must take after her mother
Hope the recovery is a quick one.

Trevor

[D4D]

We have private insurance and used it and a private hospital for the birth (cut & shut) of our first child. It was a great experience but as mentioned we received a few gap bills.

Late last year he had a febrile convulsion and the ambo took him to the nearest open emergency at a public hospital. What a depressing place, we couldn't get him out of there quick enough and took him to the Royal Children's (public) who were awesome. We always drive him ourselves to the Children's now for emergency stuff.

[Boo Boo]

Have had a familiy member rushed to a public hospital on christmas day with a heart attack, which he decided to take the private option which did give him a choice of specialists and there was no delay for all of the test that were required.

I have also kept up PHI since I was 18 when I was given my own cover from my parents.  One a few occasions I have been rushed into the Mater Private and was only ever out of pocket for the emergency room component (which is not covered by the PHI).  On my departure I was relieved that I am never out of pocket a cent, even after 4 days in intensive care.  For me with a medical condition it is worth every cent, I don't know how long I would have waited in the Public system.

[dazzler]

Hi Dazzler, sounds like she is a tough little girl. Must take after her mother
Hope the recovery is a quick one.

Trevor

Yeah mums tough, me - not so 

[dazzler]

Late last year he had a febrile convulsion and the ambo took him to the nearest open emergency at a public hospital. .

How scary are those.  Our 18mth old had one and I really thought it was all over red rover.  That worried me more than the broken elbow.   

cheers

[D4D]

How scary are those.  Our 18mth old had one and I really thought it was all over red rover.  That worried me more than the broken elbow.   

I didn't see it, my wife was Christmas shopping in Myers at the time, but I got the hysterical phone call. By the time I got there the ambos had arrived but my missus was still pretty upset. It is amazing how many people have been through the experience.

[dazzler]

No infection after 2 weeks. Pins out in six weeks.   

[Jason B]

Ooch, however it looks like a very neet job Dazzler. I dont think there will be much scaring.

Regards


Jas

[cancan]

We go public first but as soon as they mention need to be admitted we go private. Always go to mater at south Brisbane which is both public and private so the switch is easy.

[LeighC]

Public Hospitals don't receive the funding they need

You pay for private cover and never get to use it.

Public hospitals will cover the gap.

You won't get your choice in doctor but they [generally] make every attempt to offer a private room and a few other low cost benefits.

The public hospital hospital will get the revenue and put it towards much needed equipment and staffing that assists in better health outcomes.  This offsets their budget situation.

what is there to loose ?

[disclaimer - I work in the public health sector]

[dazzler]

what is there to loose ?

[disclaimer - I work in the public health sector]

Hi Leigh

Agree with everything you say.  What I dont get is that my insurer, NIB, sets its premiums based upon its outgoings and return to shareholders. 

If there are say 10000 claims a year then the cost to the fund is X (say $10million)
If all the members that go to a public hospital use the fund then the cost may be $14million.
Thats $4million that our fund has to cover and that can only be done by increasing premiums.

Say if I ran into the back of your car.  What if I said I dont have much cash can we use your insurance but I will pay the excess.  Would you? 

Thats kind of the analogy of what I am asking.  Does it effect our premiums?  (I cant see how it cannot increase them)

Maybe I am missing something

Just to reinforce I am not making any negative criticisms against the health system.  The govt yes, the employees no.