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A pressing question about private health care

Mark Ragg, whose recent report, Fine, but not fair, has generated some interesting debate about health inequalities, has a question for readers:

“Thanks all who provided comment. I accept both bouquets for presentation and brickbats for not digging deeply enough. I’d like to point out, as a meager defence, that I was well aware of the social determinants of health (such knowledge was part of the reason for writing the report), but was surprised to find that the social determinants of health care led to such glaring inequalities of outcome.

And can I ask a question. Does anybody have direct evidence that either private health insurance or private health care, per se (ie. disentangled from wealth, education and so on) leads to better health outcomes?

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Comments 6

  1. Generic Person says:

    Private health can certainly lead to quicker health outcomes, rather than years of delay in the public system.

  2. Melissa Sweet says:

    There’s a hint that this may be the case, at least for some patients, from a study of all patients diagnosed with colorectal cancer in WA between 1993 and 2003. Published in the MJA in 2007, it found an association between treatment in a private hospital and better survival rates. The authors acknowledged that their findings are not proof of cause and effect, but noted that the private patients had increased access to chemotherapy: only 45% of patients with Stage III disease who were younger than 75 received chemotherapy in public hospitals, compared with 67% of similar patients in private hospitals. The authors concluded:”If these observed improvements are a result of superior treatment, and not just patient selection, then they raise serious concerns regarding equity and access to treatment.” http://www.mja.com.au/public/issues/186_06_190307/mor11121_fm.html

  3. Generic Person says:

    Melissa, the problem with public health systems is that it is inevitable that treatment will be rationed. Although I accept the premise of public health – i.e. people should not have to die because they can’t afford a doctor – only so many people will be able to be treated with the limited funds available. It is a bottomless pit of money due to the very high demand.

    People who choose private health care do so because you can choose your own hospital, doctor and have your own room in many cases. It also allows you to bypass the sometimes extreme waiting lists in the public system for elective surgery. Some might perceive that as higher quality, but it’s mainly of higher convenience to the patient.

  4. Jon Hunt says:

    When I was working in the public system some time ago, I can’t recall a time when chemotherapy wasn’t given when the consensus was that it should have been used. They used protocols. I don’t think cost or resources were a factor. I note that the authors of the paper referred to admit to not being able to determine the cause of the better outcomes but hypothesised that it may be due to superior treatment, and provided evidence this may be the case. But it could be that the healthier ones are more likely to go private (say higher social class, non-smokers, non-drinkers etc) and got chemo because they were healthier and better able to cope without complications. And because they were healthier for a start they had better outcomes.

  5. Gavin Mooney says:

    Mark Ragg asks: “Does anybody have direct evidence that either private health insurance or private health care, per se (ie. disentangled from wealth, education and so on) leads to better health outcomes?“ Is this really the question to ask? Is it not: if there were no private care and what is currently spent on private care were transferred to the public system, would we be a healthier country?

    I don’t have “evidence” to answer this question but I am very confident that the answer must be yes. But I may be wrong so ‘twould be good to get a study done to provide this evidence. Would the private health insurers put up the money to fund it, I wonder? After all if answered in the negative it would make such a strong case for private care.

    And a PS to Generic Person. All treatment is rationed whether public or private; the only difference is the mechanism – price or time.

  6. Ian Haywood says:

    In the modern health system there are large classes of clinical work, such as most of dentistry, and the non-psychotic mental illnesses, that public hospitals don’t do, so by definition the private sector offers superior care: the alternative is no care at all!

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