On Friday hundreds of thousands of New South Wales residents awoke to the news that the way they get their healthcare was about to change dramatically.

At least, they should have, but chances are they have no idea.

Quietly, but surely, the NSW government has been radically changing the fundamental structure of healthcare in our most populous state. But so far there has been little public debate about the decision to privatise the running of the state’s hospitals, which is part of a national trend to try to outsource and reduce the ever-increasing costs of healthcare.

It culminated with the NSW health minister, Jillian Skinner, revealing to parliament that she was seeking expressions of interest from private operators to run five of the state’s hospitals.

Maitland, Wyong, Goulburn and Shellharbour hospitals would all be built and operated privately, and Bowral hospital would have services provided by the private sector. Before the last election she announced the new Northern Beaches hospital would also be privately run.

Hospitals are in a bind. There is only one source that can reliably commit to funding growing hospital healthcare costs: the federal government. And both Labor and Liberal parties have made it clear they are unwilling to commit the necessary funds.

Add to that an ideological commitment that “private” always equals “more efficient” and you have a recipe for mass privatisation of our healthcare system.

But NSW should think very carefully before it rushes down this path.

So far, the state government hasn’t met much resistance.

The optics are clever: private operation is announced along with bright, shiny, new buildings. Existing staff get to get to stay on their government contracts for two years (only to likely be forced to accept new conditions or lose their positions after this). And most importantly, public patients are promised they will still be covered as-normal in the private system. Basically, the government minimises any complaints at the time of its announcement.

But history tells us the reality of this privatisation-light isn’t always so rosy. And by the time people start getting upset it can be too late, with the government locked into a 10-, 20- or even 50-year contract with a private operator.

Just look at some examples. At Royal North Shore hospital, where the cleaning and portering (moving patients around) was outsourced, it didn’t take long for the profit-motive and quality care to come into conflict.

Doctors complained of being unable to control patient care because of resource constraints. There were reports of infectious patients being left for hours in hospital corridors, because no clean rooms were available. Incontinent patients were reportedly left lying in their own waste because there was no one to move them.

And the government was stuck in a 28-year contract with a private operator that said it could not afford to meet increased costs.

Or there are the reports of public patients being “mistakenly” refused bulk-billing by the private (not-for-profit) Chris O’Brien cancer centre, where all public cancer patients in one local health district are now being sent.

And let’s not forget the disastrous history of the Port Macquarie base hospital outsourcing, which the auditor general famously concluded had resulted in the state government “paying for the hospital twice and then giving it away”.

This is not a pattern that is isolated to NSW hospitals, with Queensland, South Australia and Victoria all facing similar scathing judgments from auditors left to rake over the pieces of failed privatisation attempts.

The problem is that hospitals carry unique difficulties when it comes to privatisation and outsourcing. They tend to be local monopolies or duopolies at best (particularly in rural and regional areas), and are always running on the smell of an oily rag; facing ever-increasing demand and costs and a public that demands equal access to the very best treatment.

Scandals in NSW such as the baby deaths in Bankstown-Lidcombe and Fairfield hospitals, chemotherapy under-dosing, and blow-outs in waiting times show how much pressure hospitals are under.

In fact, we still don’t know exactly what role the outsourcing of the installation process that was implicated in the gassing of two babies with nitrous oxide at Bankstown-Lidcombe played, although the NSW chief health officer found both private operator and hospital had not met their responsibilities.

It’s an oft-repeated (and regularly misattributed) dictum that insanity is doing the same thing over and over again and expecting different results.

So far, the pattern is clear. Outsourcing or privatising public hospitals may be an easy political sell, but adding a profit motive to the operation of hospitals that are already expected to provide more than they can afford is a risky way of doing business.