Qualitative study of patients' choice between public and private hospital emergency departments

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.

Section: Introductionmentioning

confidence: 99%

“…He and colleagues provide us with a timely, novel and important piece of research, continuing the work of identifying the rationale for patient choice of a public or private facility when facing a health emergency in Australia.…”

mentioning

confidence: 99%

Choosing public or private emergency departments in Australia

Walker

Ben‐Meir

2017

“…6,8 Interestingly, all but one paramedic said they presented because of the patient requesting to attend our private ED, indicating that specific direction could be the first point in the paramedics decision-making. The themes identified were not entirely surprising and align with previous Australian work exploring patients (as opposed to paramedics) reasons for choosing a private ED.…”

Section: Discussionmentioning

confidence: 99%

“…The themes identified were not entirely surprising and align with previous Australian work exploring patients (as opposed to paramedics) reasons for choosing a private ED. 6,8 Interestingly, all but one paramedic said they presented because of the patient requesting to attend our private ED, indicating that specific direction could be the first point in the paramedics decision-making. The other three factors are then likely to be modifying factors, influencing whether the paramedic felt the direction could be complied with or was appropriate.…”

Section: Discussionmentioning

confidence: 99%

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

Aldridge

Lim

Rogers

et al. 2018

Paramedics take into consideration when possible patient's wishes and are more likely to bring a patient to a private ED if they have specific direction from the patient or the patient's family or GP. The likelihood of presenting to a private ED is increased if the patient has an allegiance with the facility and the paramedics perceive favourably the hospital logistics and systems as well as service ethos.

“…During normal operations, public or private EDs are chosen by patients and paramedics for a variety of reasons. Patients balance financial disincentives in private against perceptions of prolonged wait times in public . Paramedics have a default practice of delivering patients to public EDs and over‐riding this practice and taking a patient to a private ED requires active decision‐making, usually at the request of a patient, family, treating general practitioner or physician …”

Section: Introductionmentioning

confidence: 99%

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

Walker

Stephenson

Dunlop

et al. 2019

We describe a novel ambulance diversion programme, piloted in Victoria. This article discusses creating increased emergency capacity during surge or disasters by utilising private EDs, tested during a recent thunderstorm asthma disaster and an influenza epidemic. Public hospitals and EDs often run at or over capacity during normal operations. This leaves limited ability to manage surges in demand, resulting in suboptimal outcomes for patients, public ED staff and ambulance services. It is feasible to create surge capacity in private EDs for public ambulance patients. Other states could consider this option to help manage health disasters.