When thinking about healthcare during pregnancy, the first question you’re
likely to ask is; should we go public or private?
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.
Get covered for childbirth and maternity
Get the best of care, and choose your hospital, obstetritian and birthing method with HBF
maternity cover.
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.