Private vs Public
When it comes to medical treatment in Australia, there are essentially two options:
- The Public System
- The Private System
Every Australian who holds a valid Medicare card is entitled to free treatment in a public hospital. In Australia we have some excellent public hospitals and many doctors who work in private practice also do sessions in public hospitals.
You are entitled to be treated for your breast cancer as a public (Medicare) patient in a public hospital. If you choose to be a public patient, Medicare will cover the costs of your treatment in a public hospital at no charge to you, but you cannot choose the particular doctor who will treat you. You will be treated by doctors nominated by the hospital, may see a different doctor at each visit and your operation may be partly or wholly performed by a trainee surgeon who will be under the supervision of a specialist consultant surgeon. Breast cancer surgery is “semi-urgent”, and delays of up to several weeks are entirely acceptable in terms of cancer outcomes/survival. Breast cancer surgery is classified as “Category One” within the public sector, and is performed as a high priority in an appropriate time frame, without long waiting times.
Private health insurance covers you for treatment as a private patient in the private hospital of your choice, with the doctor of your choosing. Private health insurance can have the following advantages: the freedom to choose your doctor, shorter waiting times for elective surgery and access to private hospitals. Private patients are given greater flexibility when scheduling elective/semi-elective surgery and shorter waiting times.
Some breast cancer patients are keen to have their surgery performed sooner than can sometimes be offered in the public system. This is often more relevant in benign (non-cancer) conditions, such as women who carry genetic abnormalities such as the BRCA gene, undergoing risk-reducing mastectomy with reconstruction, which is classified “Category Three”, and can sometimes be associated with lengthy waiting times in the public sector.
Private hospitals may be perceived as more comfortable and may offer greater flexibility and choice of admission dates. They may offer ‘luxuries’ such as single rooms and private bathrooms and amenities. In my experience, these are usually however not the main reasons that prompt women to be treated in the private sector. In my opinion, for the majority of women who choose to have their breast cancer treated in the private sector, the single most important factor influencing their decision making is the ability to select the breast surgeon of their choice.
In the private health system YOU select the breast surgeon of your choice, who will themselves physically perform your operation. Your surgeon will personally go through the informed consent process, mark you on the day of your surgery before you go to sleep indicating the correct side of surgery and the site of the incision, not delegating any of these duties to other staff members. Your surgeon will themselves personally supervise all of your postoperative care, explain to you your operative pathology results, the multidisciplinary team recommendations and arrange onward referral to medical and radiation oncologists as appropriate.
Your choice of breast surgeon may potentially be influenced by personal research you have undertaken, word of mouth recommendations from friends, family or your general practitioner. Some breast cancer patients may have a strong personal preference for a female or a male breast surgeon. Some patients may prefer to seek out a specialist breast surgeon, who treats only breast disease, rather than a general surgeon. They may wish to check out the particular surgeon’s credentials prior to making a choice, including at which institutions they completed their undergraduate medical training and post graduate surgical training, whether they completed a two year specialist breast fellowship and where, and whether they spent time overseas working at an international centre of excellence. Some may prefer a more senior surgeon, who they may perceive as being more experienced and having more expertise, whilst others may view a younger surgeon as potentially more likely to be up to date with newer and innovative techniques.
Patients increasingly and appropriately wish to be heavily involved in their medical care and treatment decisions, and a big part of being involved, is choosing your own surgeon. It’s all about personal choice, and being informed.
More information on Public vs Private treatment for breast cancer and breast reconstruction may be found on the websites of the Breast Care Network of Australia (BCNA) website and Cancer Australia.
Ultimately the decision on whether to opt for treatment in a private or public hospital is a personal choice.