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


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#51 Datrys

Posted 09 July 2013 - 10:56 AM

QUOTE (MakeLoveNotBacon @ 09/07/2013, 10:52 AM) <{POST_SNAPBACK}>
That's right, I forgot about the home care.  If you do have early discharge, they visit you at home daily.  Although I had it both times even though I didn't get early discharge so perhaps everyone gets that anyway?


Does that vary by state?  I don't know anyone who has had that.

#52 lucky 2

Posted 09 July 2013 - 11:04 AM

Ange it's not something we seem to have in Victoria that I know of, I think the post natal visits are woeful in amount, the aim is one visit with more given sometimes.

#53 Justaduck

Posted 09 July 2013 - 11:05 AM

QUOTE (AvadaKedavra @ 08/07/2013, 10:55 PM) <{POST_SNAPBACK}>
I'd wager a guess as to which group is overall more satisfied.

I went private and my (after birth) care was terrible. It was the top ranked hospital in the country and still was shocking. I am returning there but the reason being for the continuity of care and the trust in the expertise of my Ob from last time. I have had a big long chat with the NUM of the ward about the lack of care I had last time and she said they had to do a big overhaul of staffing late last year and it would not happen again & has given me her number to call at any time with questions or queries about the care.
Put simply, they had far too many mums & babies on the ward and not enough staff, I had an EEN agency nurse looking after me who didn't really know too much about what was going on with a baby unable to attach. I had had him look after me on a surgical ward previously and while I can't fault his medical care, he didn't have the knowledge to give proper care to babies. I had next to no education, when they were doing it they would disappear in the middle of it and never return. Every time I asked for help/info I would have to ask five or six times before someone would follow through, they were always going to "be back in a minute" and never came back

QUOTE (Sunnycat @ 09/07/2013, 07:00 AM) <{POST_SNAPBACK}>
Tillytake2 the midwives I know who work in private hospitals have all ended up going public and some have said they would never give birth at their respective hospitals. I don't really think its an indicator of anything other than their preferences, I don't think it's a reflection on the private or public system as such.


Different story where I am, the private midwives who I know will birth in their own hospitals, or the other local private hospital if they aren't comfortable with their co-workers seeing them in that state. Our zoned public hospital is not the best & I have heard horror stories from there.
Even back in the 80s, Mum & her co-worker both were private midwives and they had their children (me and co-workers son) at their private hospital. Their Ob didn't charge them anything more than basics though.

#54 liveworkplay

Posted 09 July 2013 - 11:05 AM

QUOTE
We can't hand out $$$ to every regional patient's family, nor can we have a full hospital in every regional town. It's not a perfect system but I wouldn't say it's in crisis. There can definitely be improvements but overall the system works for the majority of people. And no it's not "free", it's paid for with our tax money. Are you prepared to pay more taxes?


The point is, we are not regional. We live in a capital city with a tertiary teaching hospital but they cannot provide the care for the patients most at need.  It's not a case of having to go to a town with a hospital, the hospital is 7km down the road. If a public tertiary teaching hospital cannot provide care to the majority of its patients, then is isn't that a system in crisis? If a person has to flown to another state because there is no one in their own state publicly that can do the surgery, is that not a system in crisis? If someone has to wait over a year (465 days on average to be exact) to have a 10 minute cataract removal is that not a system in crisis? My mother had endometrial cancer. It was caught early and she needed a hysterectomy. She was classified level2/3 so went on the waiting list for 13 weeks for the surgery. If she had of been category 1 she would have had to been flown to Melbourne for the surgery as it would never had been able to have been done in time here. See my point now?

#55 Bluenomi

Posted 09 July 2013 - 11:08 AM

The problem is not all public (or even private) hospitals are equal. Some are great, some are far from great. Just because one person had an excellent birth publically doesn't mean everyone will. Just like not everyone has a good birth in the private system.

Personally goes private saved me a c section. My OB, who knew me, my prefered birth plan and who I knew, got DD out without having to resort to a c section. If I was public, I wouldn't have gotten that option, it would have been a c section because that would have been quicker for the on call OB.

I know lots of women who have gone private after discovering they are high risk, that alters the stats.

I wonder how my next birth will work, my hospital has recently changed their system so I'll be a private patient in the public birth suite and transfered to the private maternity ward afterwards. Does that count as a private or public birth?

#56 brindle

Posted 09 July 2013 - 11:10 AM

I didn't read all of the replies so sorry if I repeat...

I think you need to take into account that those that often will require intervention choose private. Maybe for medical reasons, or they are older as they had trouble conceiving.

Also patients from country areas that don't have adequate public hospitals that can cater to their complications, will book into private hospitals (as they can't go to public outside their area).

The numbers are just numbers. I know many who love public and many who had terrible experiences. I personally choose private as I was older and I wanted the same carer throughout. I had slight intervention at first birth (it was necessary due to medical reasons and would have happened in public too). 2nd birth was drug free and natural.

#57 liveworkplay

Posted 09 July 2013 - 11:11 AM

QUOTE
Does that vary by state? I don't know anyone who has had that.


We have one home visit by the health nurse no matter where you birth. However mine happened at 4 weeks post birth, so it isn't exactly prompt antenatal care.

#58 Datrys

Posted 09 July 2013 - 11:16 AM

QUOTE (liveworkplay @ 09/07/2013, 11:11 AM) <{POST_SNAPBACK}>
We have one home visit by the health nurse no matter where you birth. However mine happened at 4 weeks post birth, so it isn't exactly prompt antenatal care.


Oh, we get the MCHN visit.  I thought PP was talking about extended care from the hospital, though.

#59 liveworkplay

Posted 09 July 2013 - 11:16 AM

QUOTE (MakeLoveNotBacon @ 09/07/2013, 11:10 AM) <{POST_SNAPBACK}>
Yes I do.  I didn't realize he had to leave the state.  That is awful.



and the thing is, it's not the odd case. Speak to any family here is Tas and you will find at least one of their family members has been in the same situation. That's what makes me so angry about it all. As for paying more tax, If I could guarantee that my tax dollars would be spent on fixing the problem instead of sponsoring football teams (our state government sponsors not one but 2 to the tune of millions a year!)  then I would be more then happy too.

#60 Soontobegran

Posted 09 July 2013 - 11:16 AM


Why does it have to be a debate?

People choose either model of care because it best suits them, sometimes it is because they are lacking funds, sometimes it is because they believe that either one provides a superior service.

Fact is that utilising the private system neither ensures you quality or safe care, a private room or a 5 night stay, at the same time utilising the public system does not ensure you have rubbish care, a 12 hour stay and a shared room with 3 other women.

There are private hospitals that are excellent, there are public hospitals that are excellent.....conversely you can have terrible experiences at both too.


I worked in the public system for 3 decades, I am well aware of the downfalls but even more aware of it's benefits and the fact that we consistently had an approval rate from our patients of over 95% and these are women who've had all different types of delivery and different models of care.

I had my children in the Private sector but one that was attached to a major public hospital.....I had a nightmare of a first delivery but 4 subsequent easy ones. My care varied according to which staff were on. I chose private because I wanted to choose my Obstetrician and improve my chances of getting a private room.....not because I had no faith in the system I had worked in for so long.










QUOTE (TiredbutHappy @ 09/07/2013, 09:13 AM) <{POST_SNAPBACK}>
Um, no.  My OB was present at my birth, he requested I ring the hospital when I was on my way.  He was there when I arrived for both my births, the first was at 5.30 am the second at 7.00 am.  I didn't have an epidural the first time as it was too quick, the second time, as soon as I requested pain relief the  anesthetist was there within 10 minutes - and that was only because it was an out of hours call out, otherwise he would have already been at the hospital.  Most OB's have their rooms on the grounds of the hospitals so are there during the day.  I'm not sure where you're getting your information from.  I love all the generalisations from people about private hospitals that have never given birth in one.



QUOTE (TiredbutHappy @ 09/07/2013, 09:50 AM) <{POST_SNAPBACK}>
I think it depends on whether the private hospital has an NICU department.  The private one I gave birth at does.  My girlfriend who gave birth at the same hospital had preeclampsia so her twins very premature and neither had to be transferred to a public hospital.


You will be hard pressed to find a private hospital anywhere with a level one NICU unless it is the private section of a public hospital.

Private hospitals do not have medical staff on site 24/7. Your assertion that most Obstetricians have rooms on the grounds is wrong. Some do but most Obstetricians service more than one private hospital so he/she can't be everywhere at once.
They are also in and out of their rooms every day delivering women........if you've never waited for him/her to return you are very lucky.
Most will try to work at hospitals within a 20 minute drive but the most number of private women who do not have their obstetrician present at the birth are those who deliver during the night.....they do not always make it in and they will not hang around late into the evening waiting for you to deliver unless you are fully dilated as they have families, they also have to be up at the crack of dawn to visit their patients before they start room.....often at 7am and it is more than likely their sleep will be interrupted several times during the night by phone calls from midwives or patients.



All hospitals are not created equal, all obstetricians are not created equal and all midwives whether they are independent or work from a hospital are not created equal but the majority of staff care very much about their patients.......unfortunately it is not them whom a patient remembers, it is those who appear to not give a damn who leave the greatest impression.

#61 PooksLikeChristmas

Posted 09 July 2013 - 11:18 AM

Edited for overshare. You know what forget it, no one wants to see accountability they just heap the responsibility of the victims or blame it on underfunding. People can think whatever they like, I'm glad many public hospital experiences are good, but it's not the whole story. Seriously, AK, surviving the birth is great but IMO means a bit less when you're ready to end it shortly thereafter.

Edited by Pooks*potters, 09 July 2013 - 11:25 AM.


#62 lucky 2

Posted 09 July 2013 - 11:19 AM


QUOTE
Wanting continuity of care and control of birth choices (ie. elective caesarians, home birth) is seen as an optional extra that is reserved only for those who can afford private care/home birth. I disagree with that, I see it as a miserable failure on the part of the public system.

The public system is working towards offering women more continuity of care models for birthing, ie caseload MW.
These measures are have evidence to back up the model of care, hospitals need to be very careful how and where they spend their money, they have a responsibility to the community to do so.
As for the public system catering for women who want a C/S, this really is a complex issue which is way off the track for this thread.
Suffice to say some women will have C/S in the public health system for many different reasons, these things are dealt with on a case by case basis.

#63 Soontobegran

Posted 09 July 2013 - 11:24 AM

QUOTE (Saecularis Angelus @ 09/07/2013, 10:56 AM) <{POST_SNAPBACK}>
Does that vary by state?  I don't know anyone who has had that.


There are some Victorian public hospitals who will provide a daily visit for 5 days post discharge for women whom are discharged early. It will be longer if there are problems.
My DD had 8 days of daily visits which were taken over by the MCHN after this.




QUOTE (Saecularis Angelus @ 09/07/2013, 10:56 AM) <{POST_SNAPBACK}>
Does that vary by state?  I don't know anyone who has had that.


There are some Victorian public hospitals who will provide a daily visit for 5 days post discharge for women whom are discharged early. It will be longer if there are problems.
My DD had 8 days of daily visits which were taken over by the MCHN after this.




#64 Gumbette

Posted 09 July 2013 - 11:27 AM

QUOTE (soontobegran @ 09/07/2013, 11:16 AM) <{POST_SNAPBACK}>
Some do but most Obstetricians service more than one private hospital so he/she can't be everywhere at once.
They are also in and out of their rooms every day delivering women........if you've never waited for him/her to return you are very lucky.
Most will try to work at hospitals within a 20 minute drive but the most number of private women who do not have their obstetrician present at the birth are those who deliver during the night.....they do not always make it in and they will not hang around late into the evening waiting for you to deliver unless you are fully dilated as they have families, they also have to be up at the crack of dawn to visit their patients before they start room.....often at 7am and it is more than likely their sleep will be interrupted several times during the night by phone calls from midwives or patients.

Yes, I was very lucky.  He lives close to the hospital and only delivers at the one where his rooms are. The only time I have waited is during my check ups when he was delivering.  He promised during our first check up with bub 1 that either him or his partner (works out the same rooms and also only delivers at one hospital) would be at the birth.  He is awesome. wub.gif


#65 lucky 2

Posted 09 July 2013 - 11:29 AM

QUOTE
There are some Victorian public hospitals who will provide a daily visit for 5 days post discharge for women whom are discharged early. It will be longer if there are problems.
My DD had 8 days of daily visits which were taken over by the MCHN after this
.
Really curious stbg, where is this happening?
It's awesome but I didn't know it existed in Melb Metro Hosps, unfortunately, ime everything seems to be cut, cut, cut.

#66 Sentient Puddle

Posted 09 July 2013 - 11:31 AM

Box Hill used to do a few follow up visits - dont know if they still do it.  Jessie Mac also did a follow up visit with a midwife when I birthed my second child there.

#67 Guest_Sunnycat_*

Posted 09 July 2013 - 11:31 AM

QUOTE (Saecularis Angelus @ 09/07/2013, 12:16 PM) <{POST_SNAPBACK}>
Oh, we get the MCHN visit.  I thought PP was talking about extended care from the hospital, though.


In WA if you leave hospital early a midwife from the public hospital or Birth centre visit you in your home for up to 5 days post birth.

Do other states not have this?

#68 PrincessPeach

Posted 09 July 2013 - 11:32 AM

As PP have said, a lot of women choose to go Privately because it allows them to have their planned C-sections.

If these women went public, they wouldn't have that choice. So I would say these results are skewed.

However I also know a lot of women who went privately and managed to have natural deliveries with very few interventions at all.

#69 Soontobegran

Posted 09 July 2013 - 11:38 AM

QUOTE (lucky 2 @ 09/07/2013, 11:29 AM) <{POST_SNAPBACK}>
.
Really curious stbg, where is this happening?
It's awesome but I didn't know it existed in Melb Metro Hosps, unfortunately, ime everything seems to be cut, cut, cut.


A friend's DD got this at Box Hill after going home under 12 hours with her first and as far as I know The Angliss still provides dom care for their under 24 hour discharges but this may have changed recently as so much has changed there. sad.gif

My DD was in Geelong, not metro Melbourne but a large public facility with a large birth rate.

I used to be the relief dom midwife at you know where for many years. Loved it but hated the driving and hated the fact that I had to leave so many struggling mums feeling unsupported sad.gif

#70 JinksNewton

Posted 09 July 2013 - 11:53 AM

QUOTE (knottygirl @ 09/07/2013, 10:26 AM) <{POST_SNAPBACK}>
I also think a better statistic would be % of women who requested an epidural who were denied it.

Most of my friends who went public had nothing but horror stories of their experience.  Quite a few asked several times for an epidural but were told no one was available or that they didnt need it.  I also know of friends who were overdue, and begging to be induced but the public hospital refused.  One had severe back pain for 2 weeks, couldnt walk, was having sporatic contractions, and not able to sleep at all.  Eventually when she got to 42 weeks they finally agreed to induce her.

Yep. I didn't have an epidural because I was in a private hospital, I went to a private hospital BECAUSE  I wanted an epidural. That was one factor anyway, the fact that they only had single rooms,were 5 minutes from home, would let DH room in and let me stay 5 days were also big factors. They only did low risk births and c/secs  though, anyone going into labour under 36 weeks had to go to the women's and children's hospital in town.

#71 kpingitquiet

Posted 09 July 2013 - 11:59 AM

QUOTE (Saecularis Angelus @ 09/07/2013, 10:26 AM) <{POST_SNAPBACK}>
Does that vary by state?  I don't know anyone who has had that.

We had repeated visits by a hospital midwife. She even removed my bandaging and some stitches from my c/s on my own bed. THAT I appreciated. The daily weighing of kiddo and scoldings to fatten her up, not so much. But she did offer help with bfing that was useful. I don't remember how many times she came but it was several. I was also eligible for a Mothercare volunteer for minor cooking/cleaning/baby-tending, but I hated that (I REALLY don't like strangers in my territory, plus my husband was home too) and declined visits after the first. These were both standard programs through a tertiary public hospital in Adelaide. Everyone was entitled to the Mothercare service. I think the midwife visits were on an as-needed basis (early discharge, lack of transport, discharged special care babies, etc) but I'm not positive.

#72 elemeno

Posted 09 July 2013 - 12:04 PM

Public hospital nurse here. Having worked in both public and private I can say that with our wonderful public hospital we will definetly save our money and go public.
But if I lived in an area with a hospital with a terrible reputation I would go private.
It depends, so much, on the hospital in the area in which you live.

#73 epl0822

Posted 09 July 2013 - 12:13 PM

I'm sure others have mentioned this, but the intervention rates are likely skewed because more women tend to go private when they want intervention. I also think women who have complications in their pregnancy (therefore more likely requiring intervention) would prefer to have a private OB.

I had a great experience with child birth in the public system but unlike you, I couldn't get a private room. It was horrendous, I now know why people use sleep deprivation as a torture technique. The second time I decided to go private and booked at a hospital that has a nursery, so I can actually rest after giving birth - something I just couldn't do when sharing a room with another woman and her endless visitors and two crying babies. I also want an epidural as soon as I can get it, and in the public hospital they had a policy of trying gas first and only giving epidural if the gas wasn't enough.

I don't think it's a matter of one being superior to another - they both have their pros and cons. What suits you best depends on your individual circumstances. I'm paying a sh*t load of money to go private despite having PHI, and obviously that is a huge disadvantage over public where the only money we spent was on hospital parking.

#74 F.E.B.E

Posted 09 July 2013 - 12:23 PM

2 births in public hospitals. Both had birth centres.

1st birth - trouble breastfeeding so was kept in hospital for 5 days, shared with 1 other mum & baby (we got along quite well).

2nd birth - water birth, stayed 1 night in lovely birth suite and one night on ward (one other mum and baby, very noisy). Under no pressure to leave. Chose to leave and have the midwife visits instead.

In my experience they can ask if you want an early discharge but I don't know that they can force you. A private room would have been nice but I was low risk, happy with midwife care and would rather have used the money to go private on staying at home longer with my baby (pre paid parental leave).

I do think women should have choices, but I don't think that public is always a terrible choice. I experienced a good standard of care.

#75 Soontobegran

Posted 09 July 2013 - 12:27 PM

QUOTE (epl0822 @ 09/07/2013, 12:13 PM) <{POST_SNAPBACK}>
the intervention rates are likely skewed because more women tend to go private when they want intervention.


shrug.gif I am not so sure about this.
I do not think that the decision to be a private patient is made because a woman wants intervention.

She invariably wants choice of doctor, choice of private room and choice of staying longer than 24 hours.

I think it needs to be said that private obstetricians don't all give away interventions on request.




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