Public or Private Hospital for the birth: WDYT?
, Mar 08 2010 01:36 PM
65 replies to this topic
Posted 08 March 2010 - 01:36 PM
I don’t know whether to go to a public or private hospital to have our baby – I’d love to hear the experiences of some EB members so that I can weigh it up.
The short story: I knew that DH and I wanted to start a family this year, so 12 months ago we took out private health insurance, so that we would be covered by the time that we had our baby. Everything went to plan, we are now covered and we are now pregnant. All good.
But I am now feeling very stupid because I didn’t do my research on the health fund properly and while I’ve been paying over $100 a month in premiums, they don’t actually cover a great deal of the hospital cost. First up we’ll have a $500 “co-payment”, then they will only pay for the hospital fees, not for any “extras” such as seeing a specialist, needing an ultrasound, blood tests – heaven forbid if I need an emergency Caesar because hardly any of that cost would be covered.
I just want a normal birth – hopefully without drugs (but I’ll wait and see). I thought going private might give me a better level of care, and also because I can choose who I see in terms of health professional, but actually I could be several thousand dollars out of pocket by going private – money that I could otherwise use for my maternity leave. Is it really worth that cost or should I think about going public instead?
Emma, this is a really tricky question to answer and I don’t think there really can be a “yes” or “no” outcome. As you said it’s more about hearing the experiences of others, to give you some food for thought.
I have also asked Hannah Dahlen, who is the national media spokesperson for the Australian College of Midwives
and is also an associate professor of midwifery, for some tips on what you should weigh up when making your decision.
“Firstly, if Emma has a commitment to having a normal birth – if that is what she is wanting to do - then her chances of achieving that is much greater in a public hospital,” says Hannah. “Statistically there is a much greater rate of intervention (such as inductions, caesareans and so forth) in private hospitals over public hospitals.”
“And I would suggest that if her number one reason for going private is continuity of care with her obstetrician, well we now have continuity of care within the midwife profession as well. This means that Emma can choose to see the same midwife throughout her prenatal, birth and post natal time. Women using this model tend to have less medical intervention, higher rates of breastfeeding and simply greater happiness overall with the outcome and post-birth settling. This continuity of care is available for private and public patients.”
“I would suggest that Emma discuss her concerns with the hospitals of her choice. It will depend on which public hospital is in her area - some areas still don’t have this “continuity of care” model - but if her local hospital doesn’t then she could maybe check whether she can use another hospital that does.”
“And don’t forget that midwives also work very closely with obstetricians and will know if something during the pregnancy or birth is not normal, in which case she would be referred for specialist care.”
Emma, I think it’s a case of finding out what each of the hospitals in our area offers, then weighing up the pros and cons of each. Best of luck with whatever decision you make! EB Members: Did you go public or private? Do you have any tips for Emma?
Posted 10 March 2010 - 10:34 AM
As an aside, why is it, whenever this topic comes up, advice/opinion is always sought from midwives in these types of articles. I absolutely do not have a problem with the advice provided by the quoted midwife's advice. It is very sound advice.
However, it would just be nice to have an obstetrician's point of view on this topic.
Emma - I really can't offer any advice but wish you all the best with your decision.
Posted 10 March 2010 - 10:43 AM
I agree, overitin2010, I'd love to get an Obstetrician's view too. I'll keep that in mind for next time.
Posted 10 March 2010 - 11:05 AM
Firstly, it does come down to money, especially in the southern states where obstetrician fees are higher. I think most people would agree that private care is not worth going into debt for, in the area of obstetrics.
Secondly, it depends on what sort of pregnancy you are going to have. Noone has a crystal ball. If it is going to go smoothly, no dramas, you go on to have an uncomplicated vaginal delivery - then some would even say you are better off in the public system.
However, if you are going to develop any complications, eg my gestational diabetes (which affects at least 5% of pregnancies), then it is my opinion that I received better care and had more control over the outcomes in the private system. I had a private endocrinologist who I could call / email about my sugars and she would adjust them - people in the public system have to call a nurse who passes on the message, different doctors get back to them in varying time frames with varying information. Obstetrically, I was at risk for a number of complications because of the diabetes. I was seen frequently and could call up the obstetrician who knows my case at any point and ask them about what to do. Not go up to the hospital after hours to be assessed and have an after hours junior doctor decide what to do.
That raises the whole private vs public thing about doctors. You will get more junior doctors publically: that is not always a bad thing, a junior doctor may be more up to date with things. But you might be their first caesar (someone has to be!). Of course, it would be under the supervision of someone senior. You won't necessarily see the same doctor at each OB appt, although they do try to achieve that. And the whole decision about induction, induction or caesar date etc etc - may be made by a different doctor to the one you saw last time.
Those are the practicalities of the system, and I guess are probably different across different areas. But those issues are some of the ones inherent to the whole public vs private debate.
To "Emma": there are no clear answers. We are lucky in Australia that the public system is as good as it is. Your decision will at least partly rely on your financial situation. I would suggest that you should sit down and add up how much it would cost and see if you think that is doable before even considering going private.
I expect there will be plenty of responses to say that they have had a great time in the public system, and for the majority of people I think it works reasonably well. But I think just being aware of what you are paying for and what the different issues are does help make an informed decision.
Posted 10 March 2010 - 11:15 AM
I went private and it was worth every cent. I got to see the OB I wanted to see and trusted. He was great. My OB was also my FS so I have a great relationship with him. Also I was able to chose when to have DD. To cut a long story short I had pre-eclampsia and was put in hospital. My BP came down and my OB was going away for the weekend. DD was booked in the come out the following week. Any way my Ob asked if I wanted to wait a week and I said no so he did the c-section the day he was meant to go away.
Next time round I will be going private too. I just dont trust my two local hospitals. I have heard bad stories and I dont want to be in a room with other mothers and newborns.
Hope this help
Posted 10 March 2010 - 11:32 AM
I would personally never go privately. I personally think it's a rip off and have had great public care. (And I was also admitted and induced for preeclampsia with #1, I don't see how it would have been handled better with a private OB. I'm curious for the need for a caesarean with the previous poster since she was obviously far enough along to be able to choose now or next week, they are not a standard necessity for PE (blood pressure had also come down) and it was a 1st baby. Maybe there were other complications she didn't mention).
My SIL went privately recently and I'm sure she had great care. But visiting her the standard rooms were identical to the single room I got in a public hospital for free and both her and her baby contracted staph infections which can happen in any hospital but I can't say that had me thrilled about private hospitals that you pay through the nose to use (in premiums and OB fees).
Posted 10 March 2010 - 12:31 PM
My SIL went privately recently and I'm sure she had great care. But visiting her the standard rooms were identical to the single room I got in a public hospital for free and both her and her baby contracted staph infections ....
Yep, that's one thing that no amount of private hospital money can prevent!
Posted 10 March 2010 - 01:41 PM
If you really want a natural birth stay home, your chances are slim in hospital, public or private.
Posted 10 March 2010 - 01:47 PM
You can have a natural birth in a public hospital ( or private for that matter) - I did and it was great and all that I wanted. So ignore PP who seem hell bent on turning everything into a home vs hospital birth. The origional question was public vs private.
I had DD1 privately and the care was good, got my own ob but after she was born that was pretty much it. My Ob also induced me 10 days overdue and the birth was horrendous compared to DD2, who we went publicly for. I still had my own doctor and fortunately got my own room ( just how it turned out at the time) and I was allowed to go 2 weeks over with careful monitoring so went into spontaneous labour. I couldn't fault the nursing staff or doctor and it was a much better experience.
Do your homework and check out the private and public hospitals you can go to. Ask them questions and see what their response is to a natural birth. In public, I was allowed to plan my birth with DD2 and it was hassle free and relatively easy compared to DD1.
Posted 10 March 2010 - 02:25 PM
I went private with DD. I hated my birthing experience and it was over rated.
I since moved toa regional town and with DS I did share care with my GP and did go as a private patient in a public hospital. All that meant was that I had a private room. It cost me nothing.
I will do the same for this baby.
I would be worried that you are paying over a $100 a month and you are not fully covered...
Posted 10 March 2010 - 02:32 PM
Don't see the question as public or private - the question you should be asking is hospital x (your local public hospital) versus hospital y (your preferred private hospital).
The question public versus private is totally irrelevant unless you take into account the specific hospitals and caregivers that you are referring to.
My local public hospital offers one on one midwifery, my midwife worked in a small team and I could call at any time day or night and she (or whoever was on duty in the team if overnight) would call me back within minutes and deal with any queries I had. I have every confidence that if I had had any complications they would have been dealt with superbly.
In the end my bub arrived so fast that my midwife didn't make it to the birth. She was there 20 mintues later (almost 2am...) and hung around until I went home 2 hours later. But if I had had a private Ob they likely wouldn't have made it either.
And that's another reason public suits me, I prefer not to stay in hospital any longer than absolutely necessary, so not much point paying out in insurance premiums for a hospital room that I'm not going to use (since PHI doesn't cover much of the other stuff).
Posted 10 March 2010 - 02:36 PM
mumtomakandissy - the facts speak for themselves drug free natural births are rarities in hospital, I didn't make it up.
Posted 10 March 2010 - 02:46 PM
If your wanting a Normal natural delivery then public is the way to go... its free (other than blood tests and ultrasound)...
But its not only picking public or private its also to do with the quality of the hospital... some are better than otehrs.
Posted 11 March 2010 - 01:02 PM
I say public health all the way. There are going to be 'bad stories' from any hospital, public or private, you need to remember that doctors are not going to go out of thier way to stop you having the birth you want and paying them is certainly not going to make a difference in the care they give you. The main thing I thought of was where is the best NICU? In a lot of cases private hospitals don't have a neonatal department at all or as advanced and well staffed as a public hospital and although nobody wants to think their baby may need it I personally feel better about it being on the same floor rather than an ambulance ride away.
Posted 11 March 2010 - 06:54 PM
We have had 6 children in the public system and our 7th baby 4 weeks ago privately. I loved the care in the private system as it felt more personalised and continuity was there. I had a pregnancy with a higher risk and felt very at ease with the care I was given. I didn't have a bad experience in the public system just preferred the care in the private. My Ob and his team were a dream to visit at each appointment and when it came to my c/s I knew exactly whom was carrying out the surgery (unlike in the public system were I had 2 complete strangers operate on me) Having said that we had a couple of great natural births in a public birthing centre and the midwives were fantastic, like op I think it depends on the hospital you choose and I think it can depend also on the type of pregnancy you have.
We only had basic health cover and our fund would only pay a small portion for my room. To give an idea our Ob charged $3500 for the birth (we got around $2600 back from medicare), he charged around $80 per visit - also a portion could be claimed back (as with U/S and blood tests). As we weren't covered for Obstetrics by our health fund we had to pay the hospital C/S theatre fees and most of our hospital stay/room upfront and were left out of pocket $3300. Our anaesthetist charged around $1600 but we only had to pay a $290 gap.
Costs can vary greatly depending on the ob and hospital. If there had of been complications with our birth and if the baby had required special care we would have been charged more. It would have been a different story had we had more comprehensive health cover. I still feel it was worth the money.
Posted 11 March 2010 - 08:03 PM
We have had 6 children in the public system and our 7th baby 4 weeks ago privately...
Wow - that's awesome. Congratulatons!!
Posted 11 March 2010 - 08:23 PM
I had both my kids privately and it was the best experience ever, my OB was alway there the whole time for both. I never had to wait for my Epidurial as I requested it both times and recieved it, without any horror stories. My DH was always made to feel comfortable and could sleep over with me - with all meals for him available. I had scented baths and amazing midwives both times.Also you have your own room, mini fridge and ensuite - which basically means my other kids are comfortable and can stay as long as they like. We are expecting our third child and wouldn't have it any other way. Private is Ace!
Posted 11 March 2010 - 10:24 PM
I went public for baby #1 and while the birth centre care was adequate, I hated having an obstetrician I had never met on the other end of a set of forceps (and no pain relief, so I felt pretty sorry for myself). I had a private room in the the post-natal ward but i still didn't get much sleep due to baby crying all night and the nurse's call button being on constantly in the corridor - the midwives were too busy to help anybody, let alone me. - so that damn buzzer just went off all night.
I swore I would go private if I ever did anything so insane as to have another baby again.
Now expecting baby #2, and I decided to go public again! I looked at the cost and it would be about the cost of a family holiday to Fiji... mmmm I think I'd rather go to Fiji. Or more weeks on maternity leave. At the end of the day, whether I was public or private I probably still would have ended up with a forceps delivery. And I will try and go home immediately this time, regardless of stitches, and get some home help in, instead.
Going private is an awful lot of money for a fairly short experience. If I had a paid-off mortgage etc then I would definitely go private.
I would say if you go public, then it is a necessity to take your own health and care very seriously. YOu can't expect a public dr or overworked midwife to worry on your behalf. If you have any concerns at all about your pregnancy, or don't like the care you are getting, then kick up a fuss and don't take no for an answer.
Posted 11 March 2010 - 11:47 PM
i am having my baby privately in the comfort of my own home. much better solution than the public intervention-filled birth of my DD
Posted 12 March 2010 - 09:46 AM
I went private and my sister has been public with both her kids. As far as I can tell the only difference in care was that she had to share a room and was kicked out of the hospital a lot faster.
I wasn't happy with my hospital experience but will remain private next time in a different hospital. My sister also wasn't happy but for different reasons - ie she was kicked out before her milk came in after the birth of her first child. She was tougher the second time and wouldn't let them kick her out until she was ready (she had a c/s the second time).
If you go public be firm about not leaving until your milk comes in - this is especially important for the first baby because breastfeeding is hard and has to be learned. Otherwise you're paying for privacy and a few extra nights (oh and much better food!!) in the private system.
All the best!
Posted 12 March 2010 - 01:45 PM
i am having my baby privately in the comfort of my own home
It's a great way to birth on your own terms
f you go public be firm about not leaving until your milk comes in - this is especially important for the first baby because breastfeeding is hard and has to be learned.
Independent Midwifes are on call 24/7 should you need assistance in the early weeks.
Have you considered hiring an IM and even birthing in the local public hospital? That way you get fantastic 1 on 1 care and out of hospital support but you still have the security of birthing in hospital.
Posted 13 March 2010 - 05:43 PM
If you have the cover why not go private? I think its best to be informed about the choices that are available in your area - visit the wards and get a feel for the attitudes of the staff to see if they match your own.
I had DD1 privately - I appreciated having my own ob.. and my own room... and I really liked the motherly midwives at my hospital.
I'm having DS privately too - this hospital has a fantastic reputation for supporting natural births and have big baths for water births in each birthing suit. I love my ob, the midwives and I've also hired a doula so I have a "team" of people who are there for me (inc DH). The midwives are all multiskilled (some in lactation, some in hypnobirthing etc) and are very supportive of alternative forms of pain relief. I know I wouldn't get that level of care or choice in a public hospital (at least not to my knowledge).
As for the homebirthing aspect... I think that there are a lot of women who want natural births but have reasons why they choose a hospital birth and not a home birth - having a hospital birth shouldn't have to mean intervention.... although I know the stats indicate otherwise
Posted 14 March 2010 - 01:00 PM
I had a fantastic experience at my local public hospital - but as another pp said, I think this depends a lot on your local hospital. We are lucky that we are in the catchment of a lovely public hospital, with private rooms and a midwifery program for continuity of care.
I was like you, I had PHI but not top level cover so would have been quite out of pocket had I gone private. At first, I was really against going public but did some research and found our local hospital had received great reviews and a high rate of natural births.
I didn't get the drug free birth I was after, but that was more to do with my baby than the hospital. I will go to the same hopsital again next time and have since lowered our PHI premium to include no birth related services.
I suggest researching your local public hospitals - do a tour if you can and talk to them about your options.
Posted 14 March 2010 - 01:14 PM
I went private the first time. Loved my own private room for 4 days with DH bunking in - but that's not possible this time around as we also have DS (2) to look after - I will be on my own.
I also want as little intervention as medically necessary - so why pay thousands for my OB to do, well, not much, hopefully.
Last time I was not at all impressed with the care from the hospital. I love my doctor, and he did a great job, but I 'broke up' with him yesterday. He wished me well and assured me that the midwife program at the PUBLIC Family Birth Centre was excellent and I am in good hands.
I KNOW I made the right decision for me and my family, and my OB just confirmed it....
Posted 14 March 2010 - 03:23 PM
Hi Justine and Emma
We went public and wanted a caesar at 39 weeks because of blood pressure problems and concerns about our baby. However there were no beds, so we were told to go full term. This meant our 39 week health baby was stillborn at 42 weeks.
So for our next 3 kids we went private and never looked back! Now I know that this is not the norm, yet what price peace of mind? If we'd had private hospital cover we'd have a beautiful daughter to go along with our 3 beautiful boys!
There are a couple of things you can do to clarify the cost/benefit of whether or not to use the private hospital cover you already have.
Firstly, you are not required to go private even if you have private hospital cover! In a way this is similar to whether or not paying the excess on car insurance is worth having the bingle fixed by the insurer or simply paying yourself.
Public hospitals will ask you if you have private cover and automatically assume you will use it as they usually make more money admitting private patients than they do public patients. Importantly it is still your choice!
All you need to do is complete an "Admitted patient election form". The form may differ state to state as hospitals are a state responsibility. When you're admitted whatever your choice, make sure you sign this form! Otherwise you might assume you're going cost free in the public system only to find out the hospital is charging you as a private patient!
The other thing you and everybody else can do, is to ask all private doctors likely to be involved in the private hospital alternative to complete an "Informed financial consent" form. You can download an example herehttp://www.ama.com.au/system/files/node/50..._prothetics.pdf
You'll find the informed financial consent form very useful as it will help provide an estimate of your out-of-pocket costs after you've claimed on your private health insurance fund.
So Emma after you're equipped with this information it should be much easier to weigh up the pros and cons of a public or private birth.
As a simple (and maybe stupid rule) I'd always recommend going private for the 1st child. That way you'll get the advantage of the most peace of mind for the most stressful occasion the first birth! After that, you'll always be in a better position to make the choice whether to stick with private hospital cover or go public for future pregnancies. Perhaps you'll also know whether or not subsequent births are likely to be natural or caesarian.
Because we chose NOT to have private hospital cover we lost a daughter. Sadlym that's the reason why I ended up being a senior strategist working for a not-for-profit health fund - until last month when I quit my job to launch two health related websites of my own.
The first is called www.Dogtors.info
and is about my goal of creating a non-profit research organisation to study how dogs often know their owners have cancer before their owners have symptoms or doctors can even detect the cancer!
The second website I'm launching fully next month is at www.HealthInsuranceHounds.com
At this site I'll be providing lots of free information about health insurance. Notably I will NOT be paid be any health funds so I can remain fiercely independent and hopefully provide truly unbiased and balanced information about private health insurance. This may be the 1st time anybody has actually done this!
Of course Emma we all wish you a happy and healthy baby no matter which way you go!
Good luck and I hope you'll post a comment about whether it's a boy or a girl!
Best wishes, Jonathan Crabtree
Edited by SuperPuppy, 14 March 2010 - 03:38 PM.
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