How do private and public hospitals compare for efficiency and safety?
Almost all hospitals need to handle the challenge of seeing as many patients as they possibly can without compromising on safety or quality. Even if everything is done right, it’s still possible for things to go wrong. Some patients spend hours waiting in line for emergency treatment, while others have to sit on waiting lists for months on end before they can receive elective surgery that could greatly improve their quality of life.
The University of Western Australia estimates that as many as 1,500 Australians each year suffer unnecessarily poor outcomes due to overcrowding and hospital wait times. This article looks at wait times and safety at private and public hospitals so that you can better plan for the treatments you need.
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- How long are hospital wait times in Australia?
- Which treatments have the longest waiting lists?
- Are private hospitals better than public hospitals?
- Are waiting times and quality of care getting better or worse?
- Is private health insurance worth it?
- What to look for when comparing hospital health insurance
How long are hospital wait times in Australia?
One of the ways to directly compare hospital wait times, and potential overcrowding, is by examining elective surgery wait times. This is how long people needing serious but non-essential surgeries must sit on a waiting list before the hospital has the capacity to operate on them. Types of surgeries in this category may include hip replacements, or those which can otherwise wait for more than 24 hours like some cancer surgeries. Wait times vary widely by state, and are changing over time. The following table shows wait times at public hospitals. Information is not available for private hospitals, but wait times tend to be shorter there.
|State||Median elective surgery wait times (2010-2011)||Median elective surgery wait times (2014-2015)||Patients who waited more than a year for surgery (2014-2015)|
|ACT||76 days||45 days||5.3%|
|NSW||47 days||54 days||1.6%|
|NT||33 days||32 days||3.9%|
|QLD||28 days||27 days||0.5%|
|SA||38 days||37 days||1.1%|
|TAS||38 days||55 days||12.9%|
|VIC||36 days||29 days||2.4%|
|WA||29 days||29 days||0.7%|
- Hospital wait times tend to get worse in areas with a proportionally large aging population, like Tasmania. Here, 12.9% of people had to wait for more than a year before they could receive elective surgery in 2014-2015.
- Elective surgery wait times aren’t the same as general admission or emergency wait times, but they do provide a strong indication of how busy, overcrowded or understaffed hospitals are.
- Many people are anticipating that hospital wait times will get worse in the future as an increasingly aging population starts using more hospital resources.
Which treatments have the longest waiting lists?
If you are going to hospital for elective surgery, some procedures tend to have considerably longer waiting periods than others and you may wish to make plans to have the surgery at a private hospital or to cover the surgery with a private health fund rather than going in as a public patient.
The following is how long you should expect to wait for various procedures. It refers to median wait times, which means half of all patients are seen sooner than this, while the other half are seen later. Generally, the more serious your condition the shorter the wait. The three areas with the longest median wait times are:
- Ear, nose and throat surgery, 73 days: This includes tonsil removal, sleep apnoea surgery, cochlear implants and other surgical procedures that involve the ear, nose and throat. Median wait times are steadily getting longer for these. In 2011-2012 the median wait was 64 days, but now almost 5% of people are waiting more than a year for surgery.
- Ophthalmology, 70 days: This refers to eye surgeries. The median wait has stayed relatively consistent, but the number of people waiting for more than a year has shrunk, and today only about 2% of Australians are waiting more than a year for eye surgery.
- Orthopaedic surgery, 64 days: Orthopaedic surgeries address issues of the musculoskeletal system, and include procedures like hip replacements and joint reconstructions. In 2014-2015, 3.3% of Australians waited for more than a year for orthopaedic surgery.
If you are considering elective surgery in the above areas, then private health insurance can help shorten your wait times.
How do people choose?
There are more public than private hospitals in Australia, but two-thirds of elective surgeries are carried out in private hospitals.
Most people choose the private system for elective surgeries because they want to choose their doctor, significantly reduce their wait times, and because they consider private hospitals to provide higher quality procedures.
Are private hospitals better than public hospitals?
Private hospitals undoubtedly tend to have shorter wait times than public hospitals, but is the quality of treatment the same? Private hospital patients often say that private hospitals have a more enjoyable atmosphere, but does this make a meaningful difference? It can be difficult to compare public and private hospitals.
One good way of doing so, however, is by comparing quality and safety by looking at the rate at which adverse events occur while patients are in hospital. Adverse events could be anything from surgery complications to hospital-acquired infections to having a fall while in hospital. In 2015-16, across all Australian hospitals:
- Overall, 5.4% of patients reportedly suffered an adverse event while in hospital.
- The adverse event rate was 3.8% in private hospitals and 6.6% in public hospitals.
- Adverse events are more likely to occur with longer hospital stays or more serious health issues.
Private hospitals tend to report fewer issues, and their patients tend to have better outcomes. However, this does not necessarily mean that private is simply better. Public hospitals usually perform more serious and emergency surgeries, which could explain why they have higher rates of adverse events.
You can expect a good level of care in both public and private hospitals, and you cannot assume that private hospitals are necessarily of higher quality or that they provide better treatment.
Are waiting times and quality of care getting better or worse?
Waiting times and the quality of care, as determined by health outcomes, varies a lot between states, and also changes year-to-year. Providing effective healthcare to all Australians is getting more challenging as the population grows and ages, so waiting times and crowding will naturally increase over time. Even keeping the waiting times consistent requires concentrated improvement efforts.
Overall, public hospital waiting times and health outcomes are remaining fairly consistent. The main exceptions are in areas like parts of Tasmania, where a high proportion of retirees and elderly citizens mean that hospital improvements are not keeping up, or in rural areas, where medical services are more likely to go underfunded or understaffed.
It is not unreasonable to expect waiting times to get worse overall in the near future as hospital funding slows and Australia keeps hitting population size and age milestones. Health insurance may become more important to you in the future as competition for elective procedures in public hospitals gets more intense.Back to top
Is private health insurance worth it?
Everyone can benefit from having private health insurance, but not everyone can justify the costs. Some of the signs that it might be a good option for you include:
- You can afford it in the long term. Many health funds accrue loyalty bonuses for long-term customers, meaning it’s often more cost effective to find a long-term plan. You may wish to plan to have comprehensive health care with good loyalty bonuses by the time you turn 65, which is when age-related health conditions usually start multiplying and you are more likely to turn to elective surgery for maintaining your quality of life.
- You want cover for a “competitive” procedure like orthopaedic surgery, or you live in a competitive area like Tasmania. Depending on the procedure and where you live, public hospital wait times will vary enormously. For example, the median wait time for ophthalmology in Tasmanian hospitals is 214 days. In New South Wales it’s 188 days, and in Victoria it’s only 33 days. It may be worth using private health insurance to skip the queue in Tasmania, but not in Victoria.
If you are able to get it, one of the main advantages of private health insurance is that it lets you access more of the private hospitals around Australia, and avoid the potentially overcrowded public system.
What to look for when comparing hospital health insurance
If you want to skip the public hospital wait times with private health insurance then there are some features you should look out for when comparing policies.
Hospital cover: This is the section of the plan that covers your hospital benefits. Read the details of this to find out how the policy lets you opt for private hospital cover. Look for whether or not that health fund works with an affiliate network of private hospitals and which of them, if any, are near you.
Waiting period: In regards to health insurance, this doesn’t refer to hospital waiting times, but rather how long you must wait before being able to claim benefits. For example, you might take out a policy that has a 12 month waiting period for elective surgery hospital admission. This means you cannot claim any benefits for this in the first year of holding the policy. On the plus side, this 12 months might still be shorter than your public hospital wait time. Either way, it’s good to plan ahead by taking out health insurance before, not when, you need it.
Excess: This is an extra cost to be paid when making a claim. For example, your policy might have a $200 excess for all hospital claims, which means you will need to pay this sum when claiming hospital insurance benefits. Ensure that your excess is affordable and that it will not deter you from making claims or seeking important treatment.Picture: Shutterstock