When thinking about healthcare during pregnancy, the first question you’re
likely to ask is; should we go public or private?
We discuss the differences between
having a baby in the 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 $1,5001. 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.
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 hospitals1.
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, 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 HBF Maternity Report2. 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.
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 access additional 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.
Get covered for childbirth and maternity
Get the best of care, and choose your hospital, obstetrician 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. It is important to serve your 12-month waiting period prior to your due date.
Inpatient and outpatient services
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 (July 2019 to June 2020) for the above inpatient services was $305. The average
amount HBF paid for members, per birth, was $9,395.
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.
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’.
Sources:
1 Raising Children - Public hospitals: pregnancy care and birth (2017)?
2 HBF - Maternity Report (2017)