Waiting times for surgery (Part 2) - Public vs Private Hospitals

Why am I waiting so long for surgery? I've heard that I will wait longer at Hospital X compared to Hospital Y. Why can't my doctor do my operation in another hospital?

There are several factors which will determine how long you would have to wait for your surgery.  In this post, I would focus on Public vs Private Hospitals.

In general, when one falls ill their first port of call is their General Practitioner (GP). Most GPs would be able to do an array of tests to determine if you need more specialised care. He or she would refer you to a specialist in a private clinic or an outpatient clinic in a public hospital. 

Private clinic vs public hospital
In private clinics, the specialist doctor (surgeon) may bulk-bill you - that is if you have a Medicare card, you would not have to pay a gap fee. The specialist may charge a fee for the consultation where you can claim part of it from Medicare. It is best to ask when making the appointment about the fees so that you are aware what you are going to be paying. (I will have a post on Medicare and gap fees at a later time.)

In most public hospitals, an appointment at outpatients are bulk-billed.  However as resources are limited by tight budgets in most public hospitals, there are normally strict limits on what type of clinics they run and who they see at these clinics. In general, these clinics are limited to highly specialised clinics even within a specialty and sometimes not every specialty would have a clinic.

Clinics are also likely to limit taking in patients from a certain geographical area. There is also likely to be arrangements where neighbouring hospitals agree on which geographical areas they would take patients from. Very often GPs are not well versed about these boundaries as these are dependent on the patient's address rather than the address of the GP practice. Some public hospital outpatient department require a GP to fill in their referral form. So if your GP isn't sure about which hospital to refer you to, it is best to suggest he or she calls the outpatient department to check the referral process, else you might find that you would be going on a wild goose chase!

In a public hospital, you might be seen by the specialist or a doctor who is training in the specialty - Registrar. The trainee is always supervised. (I will post on a later date about doctors undergoing training).

Public vs private hospital

The surgeon would do an initial consult. He or she might want to do more tests (eg blood tests, scans, etc) or might decide there and then to recommend for you to do a surgery. When that decision is made, your surgeon will inform you about the surgery and then ask where would you want the surgery done. Most surgeons would be "credentialed" to undertake surgery at a few hospitals, some public and some private.

Surgeons have a defined block of time (what we call "list") at each hospital to undertake surgery. For example Dr A, does surgery at Hospital X every Monday from 8 am to 12 noon. This would be one the big limiting factor of when your surgery can realistically be done. Another factor is your wait category (which would be covered in a later post).

Most surgeons would have more space on their list in a private hospital than on their public. In NSW, this is due to limits to the amount of service a public hospital is funded for. Also, in a public hospital, the surgeon has to utilise surgery time for training of his or her registrar, this means each procedure would take more time.

If you elect to have your surgery done at a private hospital, it is highly likely to have your surgery done alot quicker. However, this could be a very pricey option even with private health care insurance. 

When you decide where you want your surgery done, the surgeon would write up a "Recommendation for Admission" form and send this to hospital you would be doing your surgery. At the public hospital, when the admissions office receive this form, your wait time officially starts. At most private hospitals, your doctor's staff can start liaising directly with the admissions office for a date for your surgery.

In my next post, I will talk about about the public hospital wait list.

See also...
Waiting times for surgery (Part 1) - Emergency vs Elective surgery
Waiting times for surgery (Part 3) - Wait list category