Volume 190 - Issue 9
Adverse outcomes of labour in public and private hospitals in Australia
Authors: Georgina A Sutherland, Deirdre Gartland, Jane S Yelland and Stephanie J Brown
Med J Aust 2009; 190 (9): 518-519. || doi: 10.5694/j.1326-5377.2009.tb02541.x
Published online: 4 May 2009
Published online: 4 May 2009
To the Editor: We are concerned that conclusions drawn by Robson and colleagues1 regarding perinatal outcomes in private and public hospital settings perpetuate misinformation about safe birthing options.
One of the major limitations of using routine datasets, which the authors acknowledge, is that analyses are only able to control for potential confounders held within those datasets.2 Because these datasets are not designed for research, they commonly do not contain information on all pertinent indicators. In this case, the inability to control for expected and potential pregnancy complications affecting poor perinatal outcomes means caution is warranted when drawing conclusions about the safety of public versus private intrapartum care.
The public hospital system in Australia is designed to cater for women at risk of adverse events in pregnancy and labour, regardless of their health insurance status. Women with known risk factors may opt for public care in a tertiary hospital, where neonatal intensive care facilities are available. Accounting for only a few surrogate markers of social disadvantage is unlikely to control adequately for inequities in these two very different populations. As such, the extent to which the reported odds ratios are a result of differences in the type of care provided in public and private hospitals, or underlying differences in the populations that have not been adjusted for, is unknown.
By attending to odds ratios only, Robson and colleagues have missed the opportunity to disseminate information about overall risk across both health sectors. Although statistical models used in their study indicate the risk of perinatal death is three times more likely in public than private hospitals (taking account of caveats already discussed), the population risk of such adverse perinatal outcomes is extremely small regardless of place of birth.
When using data from secondary sources, the onus is on researchers to exercise caution in interpretation and dissemination of results, because we know the media won’t. “Babies die in public hospitals ...”3 is just one example of how the general public are fed conclusions based on insubstantial evidence. We cannot foresee any benefit in undermining trust in our public hospital system. There is, however, potential for harm if women perceive they are in a substandard system of care. It is a simplistic assertion by Robson and colleagues that women can use the information presented in their article to make choices about giving birth in either the public or private sector. For many women, there is no choice.
References
- Robson SJ, Laws P, Sullivan EA. Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study. Med J Aust 2009; 190: 474-477. [Published online ahead of print, Med J Aust 16 Feb 2009.]
- Rosenberg AL, Greenfield MVH, Dimick JB. Secondary data analyses. In: Penson DF, Wei JT, editors. Clinical research methods for surgeons. Totowa, NJ: Humana Press, 2006. 0_i1091841
- Hall L. Baby toll lower in private hospitals. The Australian 2009; 16 Feb. http://www.theaustralian.news.com.au/story/0,25197,25059394-23289,00.html (accessed Feb 2009).