Public or private?

Women often ask us whether they are better off having their treatment in the public or private health system. Both have advantages and disadvantages you may like to consider.

Public

One of the main advantages of the public health system is that there are few out-of-pocket costs. Surgery, chemotherapy and radiotherapy in a public hospital are free. Breast reconstruction is also available free of charge in some public hospitals. Out-of-pocket costs can include the costs of drugs to take home with you.

You are more likely to see a breast care nurse, social worker and physiotherapist in a public hospital (many private hospitals do not offer these services). You are also more likely to have a multidisciplinary team coordinating your care, and to have access to a clinical trial.

There are, of course, some disadvantages. While the kind of treatment and the drugs you receive are the same as those in the private system, you are unlikely to be able to choose your specialists, including your surgeon. Your surgery may be performed by a registrar, under the supervision of a surgeon. While the surgeon will try to follow you through your entire treatment, he or she may not always be available. Some women see many different medical staff during their treatment and follow-up, and may not experience continuity in their care.

There may be waiting times for treatment in a public hospital. While breast cancer surgery is usually classified as urgent and so waiting times are not long, there can be much longer waiting times for breast reconstruction surgery. You may also be put on a waiting list for radiotherapy.

Private

Women who have their treatment in the private system say the main benefit is being able to choose their specialists and their hospital. This increases continuity of care and the confidence that you are seeing someone who knows you and your treatments.

Timelines for treatment are generally shorter. While this does not normally enhance survival, the shorter waiting times for test results and treatments make the cancer journey easier psychologically.

A significant disadvantage is that there may be substantial out-of-pocket costs, even with Medicare and private health insurance rebates. Talking about costs with your specialists before your treatment begins is important. Some specialists are prepared to negotiate their fees and may be able to request bulk-billing for your pathology and other tests.

Private and public

Some women choose to have their treatment across both private and public services. For example, you may have your surgery and chemotherapy in the private system, where it is covered by private health insurance, but radiotherapy in the public health system. Radiotherapy is not covered by private health insurance because is it an outpatient procedure.

Issue 72
Spring 2015