Original ArticleAll patients are not the same: An audit comparing the public and private sectorsNicht alle Patienten sind gleich – Ein Vergleich von Fuß-und Sprunggelenkspatienten im öffentlichen und privaten Versorgungssektor
Introduction
Many studies allude to differences in the private and public sectors. These differences relate to the rate of certain surgical procedures in each sector [1], [2], the presenting pathology [3], the perceptions of patient's priorities by doctors [4] and the non operative treatment provided [5].
Despite this, to the best of our knowledge, there are no papers comparing patient characteristics in the two sectors. These differences could potentially have an impact on the length of time the clinician spends with a patient in the outpatient clinic and also the surgical outcome in each sector.
With regards to consultation length it is acknowledged that certain factors such as the absence of social support, medical comorbidities, and lack of English as a primary language may all contribute to an increased consultation [6], [7], [8]. An appropriate allocation of time to see these patients must be provided. This in turn facilitates the formation of trust between the surgeon and patient at the first consultation [9] but may also lead to increased waiting times and reduced satisfaction for subsequent patients [10].
Should a patient subsequently undergo surgery, it is well known that patient factors as well as surgical factors can affect the outcome and influence the rate of complications. Patient factors include age, diabetes, obesity, ASA (American Society of Anesthesiologists) physical status and smoking [11], [12], [13], [14], [15].
The aim of our study was to compare the prevalence of such factors amongst foot and ankle surgical patients treated in the private and public sectors at different centers in Melbourne, Australia.
Australia provides both private and public medical treatment. Public medical treatment is funded by the state. Private medical healthcare is either provided by self paying patients or through medical health insurance. In 2015, 47% of Australians had private medical health insurance, covering the cost of required medical care.
Section snippets
Methods
Patient data was prospectively collected from one hundred consecutive new patients who presented to foot and ankle clinics at three different centers between July and December 2015. The centers were a private orthopedic practice, an inner city trauma center and a suburban hospital. All were located in Melbourne, Australia. Ethical approval was granted from the local institutional review board.
The private orthopedic practice was that of Mr Harvinder Bedi (senior author) an Orthopedic consultant
Results
A total of 300 patients’ records (100 for each site) were reviewed and their records were examined to ascertain demographic details. The primary presenting pathology by anatomical location is presented in Fig. 1.
The prevalence of patient characteristics (age, gender, English language and employment status), comorbidities (diabetes mellitus, ASA classification, smoking status) and access to home support are presented in Table 1. The prevalence difference along with 95% confidence limits and the
Discussion
It has been reported that there is no significant difference in the outcome of permanent cardiac pacemaker implantation among publicly and privately funded patients [17]. While this paper looks at the outcome in the two sectors we are unaware of any studies that directly compare patient characteristics and outcomes in the different sectors. This purely descriptive study is suggestive that consultation length and surgical outcomes could be affected in each sector due to varying patient
Conclusion
The results from this study show statistically significant differences in patient characteristics occurred between institutions. These factors should be considered when allocating time to see new patients in clinic, in providing appropriate levels of service, and in reviewing outcomes and complication rates following surgery.
Conflict of interest
There is no conflict of interest.
References (25)
- et al.
Women's choice? The impact of private health insurance on episiotomy rates in Australian hospitals
Midwifery
(2000) - et al.
Surgeons’ perceptions of their patients’ priorities
J Cataract Refract Surg
(2004) - et al.
Current Australian physiotherapy management of hip osteoarthritis
Physiotherapy
(2010) Cigarette smoking and foot and ankle surgery
J Foot Ankle Surg
(2011)- et al.
Impact of increasing age on outcomes of spinal fusion in adult scoliosis
World Neurosurg
(2016) - et al.
Trends in postoperative infection rates and their relationship to glycosylated hemoglobin levels in diabetic patients undergoing foot and ankle surgery
J Foot Ankle Surg
(2014) - et al.
ASA classification and perioperative variables as predictors of postoperative outcome
Br J Anaesth
(1996) - et al.
Trends of spinal fusion surgery in Australia: 1997 to 2006
ANZ J Surg
(2009) - et al.
Is mix of care influenced by the provider environment? A comparison of four care pathways in oral health
Aust Health Rev
(2015) - et al.
Determinants of consultation length in Australian general practice
Med J Aust
(2005)