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Public vs private hospital debate
Just some interesting stats on public vs private


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#1 savannah_8

Posted 08 July 2013 - 09:42 PM

Have a look at these statistics, I'm shocked http://www.mybirth.com.au/where.html
So I had my baby girl in a public victorian hospital last year and couldn't be happier with the midwives and obs I dealt with. I had caseload care throughout my pregnancy so was taken care of by the same midwife throughout and she was on call 24/7 I almost felt like a private patient with the amazing care I had, and a private room also. I came across these stats on an australian birthing website and was really shocked by the private stats, considering the amount out of pocket for private care. why are the intervention rates so high? Are the doctors pushing to get these babies out quicker? I'm not trying to put down public or private care or cause a debate, and i understand some women have certain problems throughout their pregnancy that they need special care for. I personally would have thought the stats would be switched. Seeing these make me even more convinced to go public again, why pay for private care when we have an amazing public system for free? Public all the way

Edited by savannah_8, 08 July 2013 - 09:46 PM.


#2 TillyTake2

Posted 08 July 2013 - 09:53 PM

I'm glad you had wonderful public care but unfortunately that isn't the case is many (most) public hospitals (certainly none near where I live!).

The stats are likely to be skewed by a few factors...
-age... Older patients are more likely to go private & being older are more likely to need intervention
-personal preference... People with particular personal preferences eg csec, induction etc are likely to go private to be guaranteed this choice therefore skewing the stats

Private CAN also allow you choice that prevents intervention (eg having a say in how far over you are able to go & regular monitoring so as to avoid induction... Many public hospitals just don't have the resources), choosing a caregiver who meets your ideal "needs" eg experienced & supportive of VBAC (rather than just the registrar on call that day).

#3 MintyBiscuit

Posted 08 July 2013 - 09:53 PM

I had DS in a private hospital. I had two sucks of gas and an episiotomy after a 30+ hour posterior labour. The midwives were pretty amazed. During out pre natal classes our midwife told us that epidurals, inductions and c sections were more common in that hospital compared to the comparable public hospital stats.

Why? Loads of reasons. Lots of women choose private OBs because they're high risk already, so interventions are almost a guarantee in some situations. The other women I met in the pre natal classes had a very different approach to mine - a lot of them had zero desire to have a drug free birth or a vaginal birth.

#4 Mumsyto2

Posted 08 July 2013 - 09:54 PM

Some people like being able to choose an ob that 'fits' with them & wish to be managed by them exclusively during their pregnancy. Other people don't find this important or not important enough to be significantly out of pocket.

Other people may be happy to go public just not at the hospital they are zoned for - that is they would happily attend a public hospital three suburbs over however they will not be accepted there & they don't wish to go to the public hospital they are zoned for (maybe friends/relatives have had bad experiences or whatnot). So they opt for private instead.

There are lots of reasons people have a preference for one system over the other whatever that may be. The great thing is that people do have the choice so everyone is catered for.

#5 dogma

Posted 08 July 2013 - 09:58 PM

QUOTE (HollyOllyOxenfree @ 08/07/2013, 09:53 PM) <{POST_SNAPBACK}>
The other women I met in the pre natal classes had a very different approach to mine - a lot of them had zero desire to have a drug free birth or a vaginal birth.



That's me. I went private because I wanted to have the choice, had a wonderful OB who went through all the options with me and chose the hospital based on the recommendations of friends.



#6 fairymagic

Posted 08 July 2013 - 10:03 PM

As a midwife in a private hospital I agree with PP re the above. The age of mothers in private hospitals tends to be older than in public hospitals on average therefore intervention rates are higher.

Patients with private OBs get a lot of say in their pregnancies - we would have a high number of "social" inductions simply because the mother has requested it. This usually occurs before the 40 week mark and as a result of a woman's body not necessarily being ready for birth, the interventions are often higher resulting in a higher percentage of instrumental or caesarian births. OBs going on holidays may also lead to a social induction so the woman can birth with her chosen OB provided the induction date is near the due date.

Finally, women who go privately may have other medical histories that could preclude them from birthing vaginally or cause them to not progress with their labours necessitating a caesarian.

#7 Expelliarmus

Posted 08 July 2013 - 10:05 PM

Well you were lucky with your public care, OP.

I had my first two in an area where my public care would not have been amazing and I had one intervention free. The first was forceps but since she was stuck for 2 hours that was necessary.

The time I utilised a public hopsital with a private OB was when I was induced. But not because the OB wanted to get him out quicker - he was born at 41 weeks when I developed pre-eclampsia.

The stats might say one thing but I think that qualitative research is as important as the quantitative.

So why did I pay when we have an amazing free system? Continuity of care. I couldn't just got for the midwife option, I was high risk of developing GD. The fre system wasn't that amazing where I lived. I hated the public hospital birth - and I had special treatment of a private room and a longer stay because I was private patient.

#8 seepi

Posted 08 July 2013 - 10:18 PM

In our public hospital you share a room with 4 women including one small bathroom, and shared phone. you get 3 nights for a first birth, and 1 nigh for subsequent births.

In the private hospital you get 5 nights in a single room.

I had drug free births in private. the stats just say more epidurals etc are given in private. It doesn't mean you have to have one if you don't actually want to.



#9 Justaduck

Posted 08 July 2013 - 10:22 PM

QUOTE (fairymagic @ 08/07/2013, 10:03 PM) <{POST_SNAPBACK}>
Finally, women who go privately may have other medical histories that could preclude them from birthing vaginally or cause them to not progress with their labours necessitating a caesarian.


This was me. I have respiratory issues and need a c-sec (or risk my larynx and lungs doing what they do, resulting in intubation & emergency c-sec under general) as recommended by my respiratory physician. I would have been a c-sec statistic public or private. I don't live in NSW so those stats are not relevant for my case anyway. No my Ob was not pushing to get DD out terribly early. He likes to do c-secs around 39 weeks and said pick a date from three.

Like a PP said, your local public hospital might not be the best, but one several suburbs away could. Going public you don't get to choose (in my area anyway) where you will have to go, you have to go to your catchment local hospital and that is that. That can be another factor. Not every hospital has the same midwife throughout, I know around here (unless you pay for midwifery care) you could see a different one every time.

It really does not bother me where anyone else chooses to birth your child or what your reasons for doing so are, I think if you want to go private great! If you want to go public great! As long as you are doing what you are comfortable with.

#10 wenbart

Posted 08 July 2013 - 10:26 PM

I went private with all of mine, even though I could have had them at a pretty good public hospital! Why? Because I wanted the level of care I got from my awesome doc! I was "older"  (37) and I wanted to know that in case there were any issues, I would have the continual care of doc and his staff, I was even given his pager no. I rang him with a 'issue' in one of my pregnancies, left a message, and he rang back less than 2 minutes later! Wrapt with the care I got! Why would we pay that much out of pocket? We knew that we had the baby bonus to cover it!!!! I think that in removing the baby bonus, many people will be forced back into the public system, and it will face even more over crowding and stress on an already stressed system! Glad we had our ids when we did!

#11 PooksLikeChristmas

Posted 08 July 2013 - 10:27 PM

I imagine people like myself would skew the stats. After a horrific experience at a public hospital that on paper probably looks great in the stats, I would go private if I could and I will be screaming down whatever hospital I go to for an epidural/elective c-sec. I had HG which the public hospital did absolutely nothing to assist me with managing, so if I could afford private and the ongoing, continuous support of an Ob privately I would. Etc. etc.

There was nothing empowering or wonderful about my intervention minimal birth in a public hospital and I'd rather birth alone in my backyard then go back there.

#12 Let-it-go

Posted 08 July 2013 - 10:31 PM

OP - you are basing ONE experience (being your own) and comparing it to the stats of an entire country.  Every birth is different, every womans expectations are different.

Why do we have to have this argument (sugarcoated as a 'discussion) over and over again as to whether women have drugs or no drugs, cs or vb or vbac, forceps or no forceps, midwife or OB.....it is not your business what other women choose.  Nor is it my business what you choose.  

My choices were very different to yours, but they are that.....MY choices.  And none of your business.

Edited by Ehill, 08 July 2013 - 10:33 PM.


#13 Datrys

Posted 08 July 2013 - 10:33 PM

QUOTE (savannah_8 @ 08/07/2013, 09:42 PM) <{POST_SNAPBACK}>
why are the intervention rates so high? Are the doctors pushing to get these babies out quicker?

Seeing these make me even more convinced to go public again, why pay for private care when we have an amazing public system for free?


Just my bit of anecdata, but no, my interventions weren't due to the doctor pushing.  Quite the reverse, in fact; her motto was, "If it ain't broke, don't fix it!"

Why pay for private care?  I got to spend four nights in hospital, in my own room, and DH could stay with DD and me.  I was cared for by a doctor not a nurse (mattered to me, I know some disagree).  Particularly for someone like me, who had mental health issues and needed the support, those things were well worth the fees.

#14 SlightlyLeftFeral

Posted 08 July 2013 - 10:35 PM

I loved my public hospital birth with DD. I was well looked after, all my concerns taken seriously and had my own room stayed from Thursday to Monday.

This pregnancy, a different public hospital, I've already been admitted twice due to HG hence have met a good amount of the obs and midwives. There are 2 beds per room, which is fine by me.

For me, even though I have PHI, I couldn't justify the costs and given I was happy with my first birth, why would I go private?

#15 liveworkplay

Posted 08 July 2013 - 10:36 PM

QUOTE
why pay for private care when we have an amazing public system for free? Public all the way


I am glad you can access an amazing public hospital as for the majority of Australia, this is not possible. Our public birthing suit does not have private rooms, you share a room with 3 other women, one bathroom, payphone access only. If the ward happens to be full, you are pushed to the gyne ward and may be sharing a room with an 80 year old hysterectomy patient.

I had my one c/s and two vbacs (one intervention and drug free) in three different private hospitals. Two of the three were outwardly pro natural birth, the other did not outwardly push a preference. I was able to have a private room and stay up to 5 days if I had wanted. The only out of pocket expense (besides my private OB) was a paed visit for each child (my first had hip dysplasia so a paed check was necessary) My health fund paid everything else.

My brother shattered his wrist. At our public hospital he was " locked in" at the ER for his own protection against other patients and spent 48 hours waiting for a bed. He then spent 72 hours on the "emergency surgery" list on morphine for the pain, waiting for surgery. Post surgery he was given some one elses IV drugs and it was only because I questioned the nurse as to why he required quite strong IV antibiotics that the mistake was realised.

I had a friends having to ring the ambulance from the ER waiting room as his Dad was slipping in and out of consciousness and the triage staff would not change his priority.

Not all public hospitals are created equal.

#16 lucky 2

Posted 08 July 2013 - 10:37 PM

QUOTE
Finally, women who go privately may have other medical histories that could preclude them from birthing vaginally or cause them to not progress with their labours necessitating a caesarian.

Most babies are born in the public health system.
Are women who cant afford private health insurance somehow healthier than their private health insured counterparts?
I doubt that, they are probably more likely to have health issues and many that can complicate pregnancies.
I'd wager a bet that this is not a consideration for the higher intervention rates in private hospitals.

#17 PooksLikeChristmas

Posted 08 July 2013 - 10:41 PM

But lucky2, if a woman wants to make a choice FOR intervention, she may well recognise this will be more likely in a private setting. She may have health issues and decide the continuity of care etc. is worth the extra $$. Don't you think?

#18 seepi

Posted 08 July 2013 - 10:45 PM

Like someone above I tried public the first time. Didn't like it, went private after that - much nicer. I had totally drug fee births in private and had a shot of pethidine in the public - but I put that down to it being the first birth, not the public hospital.



#19 tibs

Posted 08 July 2013 - 10:46 PM

Yep I wanted "intervention" so went private with all 3 of mine and had 3 elective c-secs, my choice. Had I gone public that choice would have been taken away as my c-secs weren't medically necessary and what I wanted wouldn't have entered in to it.  Maybe I would have gone on to have 3 intervention free births in the public system, maybe not, who knows but I'm glad I had the luxury of not having to find out.

#20 lucky 2

Posted 08 July 2013 - 10:49 PM

Yes, she might and that's fine if that's what she wants to do and can afford it, but lots of women don't have that choice (ie not privately insured) and this doesn't therefore mean that she can not have her individual needs met.
Patient or woman centred health care is best practice, in either setting (private or public).


#21 Fright bat

Posted 08 July 2013 - 10:55 PM

You are basing the whole argument on the notion that all women aspire to a 'natural' birth.

That argument, in and of itself, is flawed.

A much better statistic would be 'how satisfied is a woman with her birthing experience' rather than 'by what passage did the baby exit the womb'.

I'd wager a guess as to which group is overall more satisfied.

#22 Guest_Sunnycat_*

Posted 08 July 2013 - 11:00 PM

I don't particularly like the public hospital I'm giving birth at but also don't like the private hospitals on offer here in WA either. We wouldn't ever be able to afford to go private anyway.

There just seems to be no middle ground. I really wanted to give birth at the Birth Centre, but last time when pregnant with ds due to medical reasons couldn't (I can't fault the public care I received for the actual induction but can fault it for the medical care leading up to the induction). I was lucky enough to be transferred back to the BC afterwards and that was a lovely experience.

This time I again wanted to birth at the BC but am 1 BMI point over their maximum, so transferred out to a completely different hospital to try and get a water birth. The doctors I have met have sucked so far. I much prefer midwifery care.

Really I wish there were more Birth Centre type options to birth at and more room for negotiation rather than just blanket rules and bans.

If we have another child I'm not sure what I would do but can see why women resort to home births and free birthing as the gap between private and public is just too vast (IMO).

ETA: I don't aspire for a natural birth anyway, all I want is to feel supported and listened to and understand what is going on.

Edited by Sunnycat, 08 July 2013 - 11:08 PM.


#23 PooksLikeChristmas

Posted 08 July 2013 - 11:01 PM

QUOTE (AvadaKedavra @ 08/07/2013, 10:55 PM) <{POST_SNAPBACK}>
You are basing the whole argument on the notion that all women aspire to a 'natural' birth.

That argument, in and of itself, is flawed.

A much better statistic would be 'how satisfied is a woman with her birthing experience' rather than 'by what passage did the baby exit the womb'.

I'd wager a guess as to which group is overall more satisfied.


Exactly.

I wonder how many women go public the first time and then find the money subsequently...

Lucky2 many hospitals just aren't meeting those standards, are they. You've just got to talk to people. There are 2 hospitals in my part of the universe that get mentioned time and time again as being crap. I don't think people are making it up... Where there is smoke there is fire. And if you don't have a choice of hospital, and you don't have a choice of care, and you can possibly find the money... Well, you would, wouldn't you. Or you lie about your address, that is happening a lot too.

#24 elizabethany

Posted 08 July 2013 - 11:04 PM

Ihad a great experience going public last month, I had consistent care with one midwife, and Endo, had a couple of OB's, but they all consulted, so worked together and were great.  Private room and 3 nights in.

But I was high risk, so got into a special program that wasn't avaliable to most, and was in a new building at the hospital, so everything was top of the line.  I get that this is not the norm, but it was really good.

#25 lucky 2

Posted 08 July 2013 - 11:30 PM

I know pooks, I live in Melbourne and work in the industry so I know what (or where) you are talking about.
I don't care if women take up private health insurance and use it for maternity care.
But I will defend the quality of public care when I know that it does in fact exist.
And I will speak up if I think that private maternity care is being presented as the only way to get quality care.
I hate zoning and the lack of choice it has brought to women in some areas.
I hope the hospitals that are not meeting the needs of women keep getting complaints and improve.






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