Dr. Laura Durcan:

In terms of the complexity of care, we need to look at the patients who come to a hospital before considering any bed-for-bed cost analysis. It is a question of patient morbidity, that is, how sick they actually are. Any analysis that looks at the cost per patient or cost per hospital stay must be adjusted for comorbidities. The patients who present to us in the acute hospitals are astonishingly more unwell than the patients who present to most of the private hospitals, mostly because the former present in a crisis via the emergency department. These are people who have a comorbidity list of 20 illnesses and are taking numerous medications. It is not the same patient population presenting to the private hospitals as that which presents to public hospitals. As a result of paper-based record-keeping, as one factor, we are not very good at capturing the degree of complexity and comorbidity we are seeing in the public system. That is very much reflected in the cost of a patient stay in the public system versus the cost in the private system. It is a huge factor.