General practitioners and midwives should be allowed to manage pregnancies and births in the private hospital system, the private health insurance peak body has said.
Private Healthcare Australia made the suggestions amid what it said are concerns many Australians are turning away from private hospital maternity services due to high out-of-pocket costs, which can be as high as $6,500 in some cities.
It said health funds want to be able to fund more choices, including GP-led and midwife-led care in the private hospital system.
But the proposal has been met with criticism that it would put practitioners and patients at risk.
The National Association of Specialist Obstetricians and Gynaecologists said it had serious concerns about the proposal, adding that it would place “unrealistic financial, legal and administrative burdens on practitioners, while failing to ensure high-quality care for women and their babies”.
PHA said GPs and obstetricians should be able to offer a total package of private maternity services, with fixed out-of-pocket costs.
Under the 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.
NASOG President A/Prof Gino Pecoraro said the proposed structure would increase medico-legal risks for the lead practitioner by placing full responsibility on them, exposing them to vicarious liability for all services within the bundle.
He said the bundled payment arrangement would also leave practitioners managing contracts, payments and risk assessments, among other things, further adding to practice costs.
“We cannot expect doctors to take on the financial and legal risk of an entire maternity team. The stakes are simply too high,” he said.
“If something goes wrong, who is ultimately responsible? This is just one question the proposal fails to answer.
“This model puts more red tape between doctors and patients, which is the last thing our maternity system needs.”
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To help mitigate costs, PHA has recommended that health funds and the Australian Government each provide a minimum of $3,000 to lead practitioners.
It is estimated that it would cost the Australian Government $246 million over four years, but would save taxpayers by lowering demand on the public hospital system.
About 46% of Australians have hospital cover as part of their health insurance, and around one in four births currently occur in private hospitals.
PHA Chief Executive Dr Rachel David said patients who paid many people want 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.
“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,” Dr David said.
“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.”
A/Prof Pecoraro added that NASOG supports maternity funding reforms and the reduction of out-of-pocket costs patients.
“We need solutions that work for women and for the doctors who care for them,” A/Prof Pecoraro said.
“Private maternity care is already at risk. We cannot afford to introduce a flawed funding model that drives more doctors away.”
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