Public Hospital System v Private Hospital System

22 Oct 2015 by Krystal Barter

Pink Hope member Anita reflects on her own experience and writes this blog post not to provide advice but to offer a range of issues to consider when deciding whether to undertake risk reducing surgery in the public hospital system or the private hospital system.

Alex and Anita Keen

Making the decision to undertake preventative risk reducing surgery is hard enough and working out whether to do this through the public hospital system versus private hospital system with private health insurance can be challenging.

Public Health System Overview
To be eligible to undertake risk reducing surgery in the public system you must meet a stringent set of criteria that takes into account family history and your personal and immediate risk. There are many considerations when undertaking risk reducing surgery through the public system including:

Pros

  • The cost is ‘free’ and covered by Medicare which can save thousands of dollars
  • You need a referral for surgery through a high risk family centre or geneticist

Cons

  • Wait lists are unpredictable and because the surgery is considered elective sometimes waiting times are long (up to 2 years)
  • You can’t pick your surgeons or doctors, and you may have little choice in the hospital you would like
  • Generally recovery times are shorter in the public system, you will need to go home earlier than in a private hospital

Private Hospital System Overview
Undertaking risk reducing surgery through your private health insurance is also considered elective surgery, therefore generally speaking the out of pocket costs (or GAP) can be high depending on the type of surgery and reconstruction you select and of course the surgeon you select.

Pros

  • Choice of your surgeon, your doctor and your team – you can research who you’d like to undertake the surgery
  • Wait lists are shorter and knowing the time of your surgery can help plan for time off work, child care etc.
  • Choice of hospital – you can chose which hospital you’d like to have the surgery (providing this is suitable to your surgeon) but always contact your private health insurance to ensure it is a hospital on their to get maximum rebates
  • Private hospitals are generally more accommodating to requests for staying longer in order to recover and rest and this is important if you feel returning home too early will negatively impact your recovery

Cons

  • Out of pocket costs (or GAP) can be high depending on the type of surgery and reconstruction you select and the surgeon you select
  • You need to take control of your own choices and research who you’d like on your team and factor in the costs to cover surgeon/s, surgical assistant, anesthetist, pathology, excess cost for hospital admission

If you select to go privately, preparing financially for your surgery is important. On the Pink Hope website you can find financial resources including a spreadsheet template to help you plan for all your expenses related to your risk reducing surgery.

It is important to obtain a surgical estimates document from you surgeons and to provide these to your health fund before your surgery. This way your private health fund can guestimate likely out of pocket expenses.

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