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Public versus Private Health System
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#1 KatakaGeoGirl

Posted 12 April 2012 - 06:07 PM

SO I would like to know, as I've been discussing this out with my husband. We have never had private health insurance and can't really easily justify it.

I'm a victim of the pathetic times in the public health system - with stage 4 endo and bowel endo I should have had a bowel reconstruction and complete hysterectomy years ago, but still not even on a waiting list (was, thrown off it as specialist quit that hospital, went to different hospital they then said couldn't offer it, now at a different hospital and meet again on Monday).  I have other bumps (lipoma, liver tumour) but they are both benign. Hubby fears he may have skin issues as he has suspect moles.  Now my DD who is 5 and starting to worry about her weight and health and now 2nd UTI in short time, and our response from the children's hospital was to make us aware of the 'wait' times to even get an appointment.

So what if something was radically wrong, like if they DID find a cancerous tumour? Does the hospital react, or are you left to die? In the 18 months I thought I was dying with my endo stuff (couldn't eat, walk and in so much pain could barely move) I was told all sorts of things, from 'you need to walk more to get your bowels moving as they're clogged up' and 'you're fine' (from gyno) and all sorts of other go home and take some panadol. It took my OWN fighting of the system and meet with specialists outside the public system, to get into the system to get a laporoscopy and get a diagnosis finally. And I'm still no closer! Though its not so bad at the moment.

But what if something really went wrong? What if the phone call they left was wrong 'We think the tumour on your liver is benign still' - I mean what does 'think' mean? If they did find one day it was now cancerous would they do something, or are you still left on wait lists?

I guess I'm trying to justify is private health worth it, for the amount that you pay. Or if something went really wrong you would be treated efficiently by the public system?? I can bare with the pain and non-essentials so long as things aren't terminal. But wondered what they do when things do go bad?? Like what if my husband did get his moles checked and it did come back with a bad diagnosis? Would he be effectively treated in the public system? Or are you put on wait lists still?? And how long are those lists even for more urgent matters??

Edited by Katakacpk, 12 April 2012 - 06:09 PM.


#2 CharliMarley

Posted 12 April 2012 - 06:12 PM

I think the public system is all about triage and waiting if they don't think you are an emergency. I would never give up my Private Health Cover and never give up the fact that I am covered 100% in a private hospital. We are now on the pension and it is a struggle, but I would rather live on bread and vegemite than give up this cover and be subject to all the horrible things that go on in public hospitals.

#3 lizzzard

Posted 12 April 2012 - 06:18 PM

There will probably be people on here that are far more  knowlegable than I on this topic, but my understanding is that the public system is based on a needs-based triage model... so the neediest are put first. This *probably* means that if things were really dire, you would be cared for...as long as capacity wasn't all used up with others who were in equally precarious medical conditions....that is the risk you are taking.

#4 MintyBiscuit

Posted 13 April 2012 - 07:32 AM

I've seen things move quickly both in the public and private system when it came to things like cancer, which in both cases I'm thinking of was unfortunately terminal. It all depends on so many factors though - what your public hospitals and doctors are like, what the demand is like in your area and what your private services are like. There would still be waiting lists in the public system, but my understanding is that when things are serious you're moved up to the top of those lists.

For me, a lot of the advantage of having private cover is that I'm able to choose who treats me. I had sinus surgery a few years ago when my sinuses got so bad that I was getting constant migraines and had many days when I couldn't drive due to vision problems. In the public system I would've been waiting 6-12 months for the surgery because it wasn't urgent - instead I saw my GP, got cat scans and a referral to an ENT surgeon and was operated on within four weeks of my initial appointment.

I've always looked at PHI as insurance, just like house or car insurance - you don't want to need to use it, but if you do you're glad it's there. I don't think it can really work on a value proposition. We get a decent amount out of our PHI most years, but it was really only last year when I had DS in the private system that we would have got more out of it than we put into it IYKWIM

#5 Nora.

Posted 13 April 2012 - 08:54 AM

We have private insurance but can't afford to use it. It's ridiculous. I need my gallbladder out but the out of pocket expenses are just beyond our means at the moment.

#6 Soontobegran

Posted 13 April 2012 - 09:12 AM

The public system in Australia is a wonderful but less than perfect system. There are waiting lists for non urgent cases and immediate treatment for emergency or life threatening conditions.
Unfortunately pain and discomfort does not take a high priority unless that pain is threatening your life.
This is one of the very unfortunate shortfalls of the system which such a high percentage of Australians rely on.
If your symptoms indicate a life threatening condition you will get an immediate appointment and your investigations and treatment will be done in a timely manner so your condition will not further deteriorate.
If a test comes back which indicates cancer you do not wait.

The beauty of having PHI is that you can shop around for a doctor who can effect immediate care of a problem that is making your life miserable yet not life threatening. You have choice to not put up with pain and discomfort but it costs. sad.gif
I liken PHI to home and car insurance, you have it and spend a lot of money on it, you will almost always have an excess to pay and will often go an entire lifetime without making a claim on it but it sure is nice to know it's there if you need it.

It is a tough decision OP.

#7 PrincessPeach

Posted 13 April 2012 - 09:19 AM

QUOTE (soontobegran @ 13/04/2012, 09:12 AM) <{POST_SNAPBACK}>
The public system in Australia is a wonderful but less than perfect system. There are waiting lists for non urgent cases and immediate treatment for emergency or life threatening conditions.
Unfortunately pain and discomfort does not take a high priority unless that pain is threatening your life.
This is one of the very unfortunate shortfalls of the system which such a high percentage of Australians rely on.
If your symptoms indicate a life threatening condition you will get an immediate appointment and your investigations and treatment will be done in a timely manner so your condition will not further deteriorate.
If a test comes back which indicates cancer you do not wait.

The beauty of having PHI is that you can shop around for a doctor who can effect immediate care of a problem that is making your life miserable yet not life threatening. You have choice to not put up with pain and discomfort but it costs. sad.gif
I liken PHI to home and car insurance, you have it and spend a lot of money on it, you will almost always have an excess to pay and will often go an entire lifetime without making a claim on it but it sure is nice to know it's there if you need it.

It is a tough decision OP.



This sums up my opinion nicely.

Also a lot of private health funds have agreement doctors - so no out of pocket costs!

#8 No-pants Agnodice

Posted 13 April 2012 - 09:19 AM

The publi system is fantastic at dealing with urgent things, and less good at non-urgent things - things that might make your life incredibly miserable, but not be a danger to your life (e.g. endometriosis, joint replacements etc). I have had both public and private care and I do not believe the quality of care provided to be different, but there are real limits to the ability of the public system to deal with chronic and non-urgent conditions. That being said, there is a real limit to the private systems ability to deal with really complex situations - complex or rare diseases, very sick patients etc.

Whether or not you will benefit from PHI depends on you as an individual. I don't think there's a huge difference in maternity care, or 'minor' emergencies like a broken arm or an appendicectomy - except that private will cost you and public is free. If I needed a major operation I would go public. If I had a chronic condition requiring hospitalization and could afford it, I'd go private. If it was for a chronic condition not requiring hospitalization then I wouldn't bother with PHI as it doesn't rebate outpatient care and you could just see a private physician anyway.

#9 Expelliarmus

Posted 13 April 2012 - 09:24 AM

I would never rely on the public system alone. I recently paid about $600 out of pocket for a $9000 operation. I know how much it costs because someone else without private cover enquirer about the cost at the same facility because she was stuffed around on the waiting list and effectively bumped off it. The list, I was informed by my GP is 2-3 years in the public system.

I am now getting physio for my post operative care and am mostly pain free. The other person is now suffering from a secondary condition that makes them ineligible for the original necessary care until the secondary condition is under control.

I will always keep PHI.

#10 Guest_Telmatiaeos_*

Posted 13 April 2012 - 09:27 AM

QUOTE
If your symptoms indicate a life threatening condition you will get an immediate appointment and your investigations and treatment will be done in a timely manner so your condition will not further deteriorate.
If a test comes back which indicates cancer you do not wait.


I can vouch for this.  I was recently in a public hospital where they ran all of the tests to see if I had a life-threatening illness.  Thankfully all tests came back negative.  However I was kicked out of hospital with still very serious symptoms, one of which was still being unable to eat.  It was very distressing.

#11 mamaknits

Posted 13 April 2012 - 09:28 AM

The thing with PHI is that you do end up also spending money to use it (most of the time) as there is almost always a gap or hospital excess to pay. So you can scrape together enough to maintain the PHI premiums, but can you also scrape together enough to pay the gap and excess when you need to use it? Will you be better off putting the money away that you would spend on PHI into a high interest account and use that money when you need it for healthcare - sort of like self-insuring. We have PHI and we have found it useful and beneficial, but we're also not scrimping and saving to pay the monthly premiums.

#12 koalas

Posted 13 April 2012 - 09:38 AM

We have PHI which I keep to cover us if we have any issues I want seen to immediately.  DS is currently seeing an ENT privately as he has chronic Otitis Media.  I like being able to shop around.  This ENT is new as we weren't happy with the last ENT we were seeing.  Yes there was a gap and I was out of pocket but it was a necessary expense.

I have also experienced the public system and have been more than happy with my treatment.

#13 Soontobegran

Posted 13 April 2012 - 09:45 AM

QUOTE (Telmatiaeos @ 13/04/2012, 09:27 AM) <{POST_SNAPBACK}>
I can vouch for this.  I was recently in a public hospital where they ran all of the tests to see if I had a life-threatening illness.  Thankfully all tests came back negative.  However I was kicked out of hospital with still very serious symptoms, one of which was still being unable to eat.  It was very distressing.



As I said it is not a perfect system.
Sadly what may seem distressing to the patient is not enough reason to keep them in hospital and they can be discharged with medication and follow up care if needed.
Telmatiaos, I am certain you wouldn't have been discharged if they thought your life was at risk or your condition could be made worse by doing so.

I really get peeved when I hear the term 'kicked out'. In most cases patients are discharged because it is believed they are well enough to cope at home, sometimes with help from the hospital. Feeling ready for discharge is extremely subjective , for some it is until they are completely pain or symptom free, for others it is when they feel well enough to rest at home with their family.
I have spent almost all my working life in the public system and I trust it, I have PHI because I don't like to wait and I like to choose my doctor.
Our public hospitals in terms of equipment and care is every bit as good or better than many private hospitals.
You get discharged from private hospitals too and not always when you think you are ready.

#14 Guest_Telmatiaeos_*

Posted 13 April 2012 - 09:59 AM

STBG, with all due respect, you have no idea what happened.  You are at a different hospital in a different state.  Previously this same hospital had sent me home with internal bleeding - a ruptured ectopic pregnancy.  Yes, I'd say the system is far from perfect.

#15 *Chyloe*

Posted 13 April 2012 - 10:05 AM

We have PHI and really have it for the children.  DH used to whine about the costs of it for little return, however, our older son has glasses, DH and I have just got reading glasses, both kids will need orthodontic work in the future.  Also, 4 years ago DH himself was diagnosed with adrenocortical carcinoma, a very rare type of cancer where surgical removal is the best option.  

To date, he has had 3 surgeries, and we are extremely thankful that we have the PHI so that there is no waiting, we have a great team with the surgeon and oncologist, and to date, the PHI has paid out in excess of $60,000 for his 3 surgeries and lengthy stays in hospital each time.  

The surgeon only charged above the scheduled fee for the first surgery, for the last 2 he has not charged us above the scheduled fee so we are not out of pocket for his fees, and even with his follow up visits, he usually only charges us the Medicare amount which we pay and claim straight back.

We will not be giving up the PHI ever, as it is likely that it will need to be used again, especially as DH's tumour is now inoperable and it is quite likely he will end up back in hospital at some point.  sad.gif  This time he has had 15 radiation treatments (last one today), however, ACC does not usually respond to radiation, but we are keeping our fingers crossed for a good outcome.  original.gif

Edited by *Chyloe*, 13 April 2012 - 10:07 AM.


#16 Chelara

Posted 13 April 2012 - 10:18 AM

I don't have phi. I have seen people at the mercy of the publi system. Ie my brother with chronic back problems and pain. Kept on heavy duty drugs, later epidurals just so he could get by while waiting years for his spinal surgery. He often couldn't walk, make it to the toilet, shower or sleep due to the pain. In the end he paid for it himself, at least now he can work and get off centerlink. His mental health had suffered, his dignity had suffered, he's even more overweight due to not being able to walk or exercise. In the long term more problems were caused by letting him go for so long without a fairly simple surgery.

Being spinal surgery and needing a neurosurgeon to do it he was never going to trump patients with brain tumors, spinal cord damage, strokes etc. his wait had no end in sight, despite it actually being a fairly inexpensive op- one which you still can't afford after years off work due to back injury!

I believe in the public system in a lot of cases but there certainly are times when private cover is the way to go.

#17 Soontobegran

Posted 13 April 2012 - 10:27 AM

QUOTE (Telmatiaeos @ 13/04/2012, 09:59 AM) <{POST_SNAPBACK}>
STBG, with all due respect, you have no idea what happened.  You are at a different hospital in a different state.  Previously this same hospital had sent me home with internal bleeding - a ruptured ectopic pregnancy.  Yes, I'd say the system is far from perfect.


I am very sorry that happened to you, as I said it is an imperfect system. I am sure you would have been readmitted once the diagnosis was confirmed and I hope you were cared for properly.


#18 KatakaGeoGirl

Posted 13 April 2012 - 11:18 AM

Thanks for all your replies. No closer to thinking what I should do. My DD will need orthdontal care in the future so got to consider that as well as DH glasses, our required teeth work and my issues. My lipoma isn't causing issue at all, except it is obvious like a small half golf ball sitting on my shoulder. The liver stuff - so long as it is benign it is fine (though my LFT's keep going up and down too), the endo - IF the appointment on Monday goes well then I'll be happy to go public again this is a situation I don't even know if I can go privately as it is a highly specialised surgery hence the difficulty finding surgeons who will perform the surgery (there are now only 2 hospitals in VIC that can help me apparently). So I guess I'll sit tight a bit longer... but if this surgery falls through I will have no choice. I can't take the pill anymore due to FVL + and also can't take a progesterone pill as I ended up with severe rashes and allergies. So I have to have something done at some stage...

#19 Expelliarmus

Posted 13 April 2012 - 11:20 AM

The thing with PHI is that, even if the surgery can only be done in the public system, it can expedite the process because if they have a private list you can get on that quicker than on their public list.

That may not be the case here but I have heard of that happening.

#20 whydoibother

Posted 13 April 2012 - 11:26 AM

They react-my step dad has been battling prostate cancer and he was seen jsut as fast in the public system and by the best specialists in the field.

#21 Maple Leaf

Posted 13 April 2012 - 04:24 PM

QUOTE
But what if something really went wrong?


Something went very wrong with my father. He was diagnosed with a 9cm renal tumour (cancer) and his kidney was imploding.
The public health system told him he needs to wait a month for surgery! They had written him off. Their excuse "there are other people on the waiting list, sorry"

Private system took him and operated in 3 days and saved his life. His surgeon was in shock that they didn't operate on him in the public system, that he wasn't deemed an extreme case..he needed immediate surgery, it was obvious. I am 100% sure he would have died had he waited the month in the public hospital. His pain was excrutiating, he was asking for someone to kill him as he was in so much agony. Pain meds were not touching the pain of his kidney disintegrating. His other kidney would have packed it in as well while he waited.

So..do I think private health is worth it? YES.

QUOTE
If a test comes back which indicates cancer you do not wait.


For my family, this isn't true. Prior to my father's experience I would have believed that as well, but no way do I believe that now.

Edited by Maple Leaf, 13 April 2012 - 04:29 PM.


#22 ~TSC~

Posted 13 April 2012 - 06:24 PM

I actually believe that in Tasmania now, PHI is almost a necessity and we will be treating it that way.  
You do get priority treatment if diagnosed as urgent, however that relies on correct diagnosis doesn't it.  
The current wait list where I live for a bowel resection following a cancer diagnosis is around 6 weeks publicly, max of 2 weeks privately, often more likely 10 days.  However, that does of course change if there is an immediate life threatening issue.

In 2010/11 - I had 3 general anaesthetics privately from day surgery to a 2 night stay.  PHI allowed me to see the surgeon of choice on all occasions, choose my admission dates that fitted best with my family - but more importantly I chose those admission dates as to the anaesthetists who were doing the lists.  PHI gives you choice.  

Before we moved here, my husband knew that if i needed general surgery and a particular surgeon was on - he was to take me to the next regional hospital.

#23 Guest_Telmatiaeos_*

Posted 13 April 2012 - 06:28 PM

QUOTE
Private system took him and operated in 3 days and saved his life. His surgeon was in shock that they didn't operate on him in the public system, that he wasn't deemed an extreme case..he needed immediate surgery, it was obvious. I am 100% sure he would have died had he waited the month in the public hospital. His pain was excrutiating, he was asking for someone to kill him as he was in so much agony. Pain meds were not touching the pain of his kidney disintegrating. His other kidney would have packed it in as well while he waited.


sad.gif   How awful.  We're a wealthy country.  Nobody should be having to go through that.

#24 Feralishous

Posted 13 April 2012 - 06:42 PM

for us its a neccessity.
we havent had any gap for obstetrics or my glasses/dentist so far, and have been really happy with the cover.

#25 roses99

Posted 13 April 2012 - 06:43 PM

I consider PHI to be a necessity, to prevent the exact circumstances you find yourself in.

I want to have choice when it comes to our health, and especially our kids' health.

It's not just about being treatment for life-threatening problems. It's also about quality of life.

My son needed grommets and his adenoids out. He was struggling with constant ear infections and he had been assessed as having moderate hearing loss and speech delay. Our private ENT (who, in our town, also works the public list) told us he'd be 2-3 years on the public list. The same doctor booked him in privately within two weeks.

Sure, it wasn't life threatening. But waiting an extra two or three years would have meant further speech delay, possible scarring from recurrent ear infections and possible permanent hearing loss.

My father in law needed surgery but was told he'd be waiting on the private list in Bundaberg 'forever'. Seriously. He was told by the surgeon that - because it wasn't urgent or likely to become terribly urgent - he may never get to the top of the list. And yet, he was in constant pain and his condition was affecting his ability to work. In the end, a friend who was a surgeon performed it gratis in another hospital.




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