Choosing public or private emergency departments in Australia

Abstract

Emergency medicine was once exclusively provided in public hospitals in Australia, but now over half a million consultations per annum are in private (7% total emergency consultations). Private EDs have excess capacity and are staffed by senior doctors (majority FACEM) with open access to investigations and broad specialist inpatient services. Public EDs struggle with rising attendances and overcapacity. Private hospitals have high levels of patient satisfaction and aim to optimise service provision. A major barrier to private ED attendances is out-of-pocket costs. Insurers deem private EDs outpatient services and therefore do not contribute any funding to these attendances. Additionally state governments provide no funding while Medicare items cover only 10-15% of costs. Out-of-pocket consultation costs to patients vary nationally ($110-$480) but never cover the full cost of providing services. Patients may also pay out-of-pocket costs for investigations. Private EDs can provide many benefits to patients and the community. Patients can see senior doctors immediately (at less cost per patient than public EDs). Demand can be directed away from resource-poor public EDs. Private EDs could also provide extra surge capacity during disasters. There is a need for further strong advocacy for private emergency medicine at many levels, particularly regarding the lack of funding. Stakeholder relationships should be strengthened. Research and education about decision-making in the choice between public and private ED attendance should be encouraged, particularly regarding paramedic advice to patients. Finally, patients who have purchased private insurance should be able to utilise it during evaluation of an acute illness.

Description and cost‐analysis of emergency department attendances for hand and wrist injuries

“…This could be due to patients being transferred from the ED to another ward for ongoing care, cost shifting or data entry error. A recent perspective article published in Emergency Medicine Australasia suggests that a single ED visit to a public hospital in Australia is approximately $605 . Therefore, our results should be interpreted with caution.…”

“…A recent perspective article published in Emergency Medicine Australasia suggests that a single ED visit to a public hospital in Australia is approximately $605. 28 Therefore, our results should be interpreted with caution.…”

Australian private emergency departments can assist ambulance services by taking public emergency patients during surge and disasters

“…Senior doctors and nurses staff private EDs in a relatively resource‐rich practice environment. They sometimes have excess capacity and availability to respond to greater numbers of patients …”

“…They sometimes have excess capacity and availability to respond to greater numbers of patients. 3 Private hospitals that admit emergency patients usually have access to a broad range of tertiary in-patient services, including ICU and theatres, making them suitable for almost all patients. 5 Public patients that were excluded from transfer to private EDs in the recent Victorian experience were those with an infectious respiratory disease, major trauma or psychiatric/behavioural disorders, because of resource availability and/ or lack of in-patient capability.…”

Why do paramedics choose to bring patients to a private emergency department?

“…1,2 Public EDs are frequently overcrowded, 3 as presentations are increasing by 2.6% per year on average, 1 with a concurrent increase in patient complexity 4 and without any increase in resources. 5 Understanding patient motivations and influences for choosing between public and private systems could help private EDs increase their workload and alleviate some of the strain on public facilities. Coordinated strategies to increase patient volume in private EDs have not been well described.…”