Public or private? Knowing your options

A place to start

Jennifer Solitario, HBF Executive General Manager Health & Wellness, suggests, “It’s a case of weighing up the pros and cons of both healthcare systems, and matching these with your own personal circumstances and priorities. In the end, some people are quite happy to have a baby in the public system. Others are willing to pay that bit extra for the added choice, continuity of care and comfort you get from going private.”

So, what are the pros and cons? Below we discuss the differences between having a baby in WA’s public and private health systems, and explain important factors to consider, including inpatient and outpatient services, waiting lists and specialist fees.

Going public

The main reason parents opt to have their baby in the public health system is because it generally costs less than having your baby in the private system. If you have a Medicare card, the cost of pregnancy care and having a baby in the public system can range from nothing to $1,500. If you have your baby in the public system, consultations and healthcare performed by obstetricians, anaesthetists and paediatricians for you and your baby are often fully covered by Medicare.

During your pregnancy, you may experience out of pocket costs for appointments with your general practitioner (GP) if they don’t bulk bill patients. Other expenses, which may be partially covered by Medicare, but still attract an out of pocket cost, include: blood tests, ultrasound scans, antenatal classes and consultations with a doula, if you choose to hire one. Your total out of pocket will largely be determined by the healthcare providers you choose to go with.

As with most things in life, when you opt for a service that costs less than others, you're likely to make some compromises on quality and experience.

Some things to consider if you choose to go public, include:

Access to specialists

Your healthcare check-ups during pregnancy are likely to be predominantly with a midwife, as opposed to an obstetrician.

Choice of specialist

You will not get to choose which obstetrician delivers your baby.

Continuity of care

When you have health check-ups during your pregnancy, you may see a different midwife or obstetrician each time. It generally depends on who is on duty at the time.

Choice of birthing method

You will only have the option of a caesarean birth when it is deemed medically necessary.

Length of stay in hospital

Patients in public hospitals are, on average, discharged two days after giving birth, which is a shorter length of stay than patients who give birth in private hospitals.

Experience while in hospital

You may have to spend the days after giving birth in a shared room with other patients, and your partner (or main support person) is not guaranteed to be able to stay overnight in the hospital with you.

Going private

Having a baby is one of the most special experiences in life. Parents who choose to have their baby in the private system most often do so because they value the added choice, continuity of care and overall level of comfort they experience during pregnancy, during the birth itself, and in the days immediately following the birth. If you have private health insurance (with maternity cover), the cost of having a baby, including healthcare during pregnancy, will start from approximately $3,000. We list these costs on pages 10-18 of the Report. Parents are prepared to pay more for:

Choice of specialist

You can choose your obstetrician, so you can be almost certain your chosen obstetrician will be the obstetrician who delivers your baby.

Access to specialists

During pregnancy, you have regular healthcare check-ups with the obstetrician you’ve chosen to deliver your baby. Your obstetrician, generally, has a small team that comprises a midwife, paediatrician, anaesthetist and fellow obstetricians who they work with regularly, so you get access to them through your obstetrician too.

Continuity of care

When you have health check-ups during your pregnancy, they are all with your obstetrician of choice, or their small team of specialists, such as their dedicated midwife. You will know who you will see at each appointment.

Choice of birthing method

You can discuss with your obstetrician the option of a caesarean, as opposed to a vaginal delivery. Your chosen obstetrician, however, will ultimately decide whether it’s suitable for you to have a caesarean birth.

Length of stay in hospital

HBF members in private hospitals are, on average, discharged three days after a natural, uncomplicated delivery, and five days after a caesarean-birth, which is a longer length of stay, on average, compared to patients who give birth in public hospitals.

Experience while in hospital

After the delivery, you’re likely to stay in a private room, which often includes a bed for your partner (or support person) so they can spend the first few nights with you and your new baby.

The extra time in hospital before discharge allows you to receive more comprehensive advice and support from specialist healthcare providers such as neonatal paediatricians, physiotherapists, obstetricians, midwives and nurses on things like breastfeeding, settling your baby, and post-natal recovery exercises for your body like remedial massage.

 

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Important things to know if you’re thinking about going private

Waiting periods

Generally, Australian private health insurers require members to serve a 12-month waiting period before they begin claiming benefits (money back) for maternity-related healthcare services in hospital. This means, if you’re thinking about starting a family, you should ensure your private hospital insurance policy includes maternity cover at least three months before you fall pregnant. It is important to serve your 12-month waiting period prior to your due date.

Jennifer Solitario, HBF Executive General Manager Health & Wellness, suggests starting a family is also a good reason to consider cover options for extras (or ancillary) healthcare services, “Our claims data shows physiotherapy, including pre- and post-natal exercise classes, chiropractic manipulation, and strengthening consultations are the most common services claimed by pregnant women.” Waiting periods for extras services vary, but most have a two-month waiting period, across all Australian health funds.

Inpatient and outpatient services

Ms Solitario says, “Knowing the difference between inpatient and outpatient services, and the legalities that determine which services health insurers can pay a benefit for, will give you a good understanding of the likely out of pocket costs you’ll have if you choose to have your baby in the private system.”

Under Australian law, health insurers are only allowed to pay a hospital insurance benefit on inpatient services. An inpatient is a patient who is admitted into hospital for medical treatment.

Maternity-related services you’re likely to receive as an inpatient (and therefore will receive a benefit for if you have private hospital insurance, with maternity cover included in your policy), include:

• Hospital accommodation
• Theatre and surgical fees
• Specialists’ fees (such as obstetricians and anaesthetists)
• In-hospital pharmaceuticals and dressings
• Diagnostic tests

The average out of pocket an HBF member paid per birth (January – September 2016) for the above inpatient services was $1,273. The average amount HBF paid for members, per birth, was $9,862.

An outpatient is a patient who receives medical treatment, but does not require admission to hospital. By law, health funds cannot pay a hospital insurance benefit on any treatment you receive as an outpatient and you’ll have to rely on a Medicare benefit to reduce your out of pocket expense.

Ms Solitario explains, “If you opt to have your baby in the private system, you are likely to have some out of pockets for outpatient services, such as obstetrician consultations and ultrasound scans during pregnancy. Generally, you’ll receive a Medicare rebate on these services, but investigate this ahead of any appointments by calling the healthcare provider, asking them what their fee is, and what your likely out of pocket expenses will be.”

Specialist fees

For deliveries in private hospitals, one of the main reasons out of pocket costs vary for different patients is the disparity between specialist fees. In a private hospital, the government will pay 75 per cent of a set rate (this is the Medicare Schedule Fee), and your private health insurer pays the remaining 25 per cent. However, if specialists such as your obstetrician, paediatrician or anaesthetist choose to charge over the schedule rate, you will need to cover the difference. This is commonly referred to as the ‘gap’ or ‘out of pocket cost’.

New Care Models

Some maternity care models look to change and challenge the traditional choice of public maternity care and private specialist maternity care discussed above. HBF now has an arrangement with One For Women to help reduce some of the out of pocket costs associated with antenatal, maternity and postnatal care for eligible HBF members. The One For Women offering relies on a mix of GP obstetricians and midwives caring for the patient throughout her maternity journey and a One For Women specialist or GP Obstetrician on call at the time to assist in the delivery.

This means that:

• when you have health check-ups during your pregnancy, you may see a different midwife or GP obstetrician each time. It generally depends on who is on duty at the time; and
• while your delivery will take place in a participating private hospital, you cannot choose which specialist or GP obstetrician delivers your baby and you may not have met the specialist or GP obstetrician who will assist in the delivery prior to birth.

To find out more, please see One For Women page.

Ms Solitario advises expecting parents to research their options before choosing their specialists, “Specialist fees can vary greatly, so shop around. Before you choose your obstetrician, I’d recommend comparing fees of a few. And you should ask your health fund which obstetricians they have ‘no gap’ arrangements with. Choosing an obstetrician who has a ‘no gap’ arrangement will bring down your out of pocket cost.”

“Your obstetrician will often choose which paediatrician and anaesthetist they call on for support during the birth and for subsequent check-ups. Once you’ve settled on your obstetrician, it’s a good idea to ask them whether the anaesthetists they work with also have ‘no-gap’ arrangements with your health fund,” Ms Solitario says.