Private healthcare calls for maternity care funding for GPs

Private hospital maternity care could be more affordable if GPs and midwives were funded by health insurers to manage pregnancies and births within the private system, according to a new proposal from Private Healthcare Australia (PHA).
 
The proposal – part of a budget submission to the Federal Government – comes as affordability becomes a key factor in many Australians foregoing private hospital maternity services.
 
Currently around 46% of Australians have hospital cover as part of their health insurance, and about one in four births are in private hospitals, according to the PHA.
 
While many women want the benefits of private hospital birth, such as choice of doctor and a private room, out-of-pocket expenses can exceed $6500 in some cities, said PHA CEO Dr Rachel David.
 
‘We want to create more affordable options that health insurers are prepared to help fund,’ Dr David said.
 
‘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.’
 
At present, health insurers cannot fund a midwife or GP to manage a pregnancy or birth in the private hospital system; they can only pay for in-hospital care, not the management of a pregnancy in the lead up to birth.
 
Instead, women must pay a private obstetrician to manage their antenatal care in a private hospital. And, in many cases, not all out-of-pocket costs are transparent from the outset, with unexpected costs sometimes incurred after the baby’s delivery.
 
The proposed model has raised questions from both the past and present Chairs of RACGP Specific Interests Antenatal and Postnatal Care, particularly around the frequent unpredictability of childbirth.
 
Current Chair, Dr Ka-Kiu Cheung, told newsGP pregnancies could ‘rapidly become more complex or high risk’, but within current models of care there were ‘well-known pathways to escalate care’.
 
‘What would the framework for shared care look like within a bundled maternity payment?’ Dr Cheung said. ‘And would vulnerable women at higher risk of pregnancy complications risk poorer access?’
 
Past Chair, Dr Wendy Burton, questioned whether it was ‘simply too late’ for GPs to re-enter the private obstetrics sector.
 
‘GPs were pushed out of private obstetric service provision when I was a young GP in the 1990s,’ Dr Burton told newsGP.
 
‘There are quite a number of GP obstetricians working in the rural areas … they have been practising outside the cities, but are unable to continue their practice and lose their skills.’
 
Dr Burton said out-of-pocket expenses may also prove to be a stumbling block for GPs.
 
‘We can’t compete on price with a fully funded public system,’ she said.
 
In the PHA proposal, midwives, GPs and obstetricians could offer a total package of private maternity services, including pregnancy care, with fixed out-of-pocket costs, so families would not have to incur unexpected costs.
 
However, Dr Burton said the potential variables that were ‘not necessarily known on the day a woman goes into labour’ would make it hard to set a fixed price.
 
‘A fixed price arrangement is very difficult when 30% of births in the public system are by caesarean,’ she said.
 
‘I’m not sure of how many of those are emergency, however, there is a big difference between the cost base for a vaginal birth versus an emergency caesarean.
 
‘Private midwifery options exclude women from the option of a forceps or caesarean section, should that be required.
 
‘There’s a lot of nuance that would need to be determined before anyone would pick up this model of care.’
 
Under the PHA’s proposed model, all care services provided during the pregnancy and birth would also be coordinated by one lead practitioner, including the provision of a single bill for all services.
 
For this administrative work, which would also include negotiating fees for other service providers, a lead practitioner would receive a minimum $3000 payment.
 
The PHA said while this would cost the Australian Government around $246 million over four years, it would save money by taking pressure off the public hospital system.
 
Dr Cheung said GPs should be adequately funded to provide quality maternity care, particularly for low-risk pregnancies, which in turn would give hospitals capacity to provide care for more complex pregnancies.
 
‘General practice is the most cost-effective component of the health system,’ she said.
 
Meanwhile, Dr Burton questioned whether private insurers were trying to put pressure on private obstetricians by suggesting a ‘cheaper workforce’ could be made available under the proposed model.
 
‘The principle of “equal work, equal pay” should apply here,’ she said.
 
‘I don’t think they should expect GP obstetricians who have the skills to do emergency caesarean and forceps deliveries to do that for a lower price than a private obstetrician.

‘There are quite a number of GP obstetricians working in the rural areas, but if they move to an area where they can’t continue to work as a GP obstetricians, they lose their skills.
 
‘The devil is always in the detail.’
 
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families GPs maternity midwives obstetrician obstetrics private health