A lead practitioner of the woman’s choosing would coordinate all care, including costings, meaning more certainty for expectant parents.
Health insurers want to make private maternity care more affordable by calling for midwives, GPs and obstetricians to be allowed to offer a total package of private maternity services, including pregnancy care in the lead-up to birth, with fixed out-of-pocket costs.
Currently health funds can only legally pay for in-hospital care, not the management of a pregnancy in the lead-up to birth. Health funds cannot fund a midwife or GP to manage a pregnancy or birth in the private hospital system.
In a budget submission to the federal government, private funds’ peak body Private Healthcare Australia said women must currently pay a private obstetrician directly to manage their pregnancy and deliver their baby in a private hospital.
This often includes uncertain and high out-of-pocket costs charged for consultations, scans and pathology, among other services. Sometimes those costs are not disclosed at the start of a pregnancy, leading to unexpected costs.
“Many women are attracted to the benefits of a private hospital birth, which offers the choice of your own doctor, continuity of care and your own room, but the costs are rapidly becoming prohibitive,” said Dr Rachel David, CEO of Private Healthcare Australia.
“We want to create more affordable options that health insurers are prepared to help fund.
“We know many women would like to engage their own midwife or GP with obstetrics experience to care for them in the private system, particularly if they have a low-risk pregnancy. But there’s no funding model set up for this.
“We also want options for women to engage a private obstetrician and midwife under a shared care arrangement where the midwife can call the obstetrician for input when necessary.
“These shared care arrangements maximise the use of both health professionals’ skills.”
In the public hospital system, women with low-risk pregnancies were often cared for by midwives without the need for an obstetrician, and GPs with additional training in obstetrics often delivered babies in regional and rural areas.
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Under PHA’s proposed model, one lead practitioner would coordinate all the services required. This would include negotiating remuneration for other service providers, with the lead practitioner providing a single bill to the patient covering all the services required.
To compensate lead practitioners for the administrative burden and to reduce overall out-of-pocket costs for consumers, PHA recommended health funds and the federal government each provide a minimum of $3000 to lead practitioners who undertake the task of coordinating care and providing a single bill to the patient.
This would cost the federal government around $246 million over four years but would save money overall by “lowering demand for the public hospital system”, said the PHA submission.
Associate Professor Gino Pecoraro, president of the National Association of Specialist Obstetricians and Gynaecologists, told the Sydney Morning Herald that choice was important, but an obstetrician was still required in about 20% of births.
“Only a specialist obstetrician can guarantee that they can be the ones to deliver a woman’s baby safely in absolutely every situation,” he said.
