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Pregnancy & Birth Services: The Public System Vs Private System

Jonathan August 18th, 2017 0 comments

Here in Australia, we’re lucky enough to have a great public health care system in the form of Medicare. One of the main benefits of this is free public hospital treatment if you are treated as a public patient in a public hospital or subsidised treatment if you are treated as a private patient in a public hospital. This extends to women who are giving birth in the public health care system, although some women choose to use a private hospital instead. Here, we look at what you can expect in both the public and private health care system.

 The Public System

  • Giving birth usually involves no out-of-pocket costs. Even scans and antenatal classes can be covered free of charge.
  • Appointments will take place at the public clinic of your local hospital. You may see a midwife for check-ups and a doctor at regular intervals during your pregnancy. GP shared care is also an option, with appointments being shared between your GP and the clinic but your GP must be accredited in obstetrics and have a special interest in the area.
  • You don’t have the freedom to choose your obstetrician in the public system. It is possible to elect a private obstetrician if you don’t have health insurance but this will usually require upfront payment and the full bill to be settled before you leave hospital with your baby,
  • You will often see different midwives or doctors for each appointment, although many hospitals are trying to introduce greater continuity of care.
  • Accommodation in public hospitals will usually be shared rooms. If you are a private patient in a public hospital, you will have greater priority for a single room but this depends on one becoming available at the right time and you are not guaranteed to be in your own room.
  • Some areas have birthing centres, with a much greater focus on a more natural approach to delivery. Pain relief is therefore kept to a minimum. Here, you may be allocated a midwife who will care for you throughout your paregnancy and during the birth but there are no guarantees on this. Many birthing centres work in small teams but there are no guarantees on continuity of care.
  • Birthing centres are part of the public system so there are no costs to pay but they only accept low risk patients who are not expected to have a difficult delivery. This is not an option for women wanting to have a vaginal birth after a previous caesarian delivery. Be aware that there may be costs to pay if complications occur and you need to be transferred to the main hospital.
  • Many public hospitals do not allow elective caesarians if there is no medical reason that requires that this needs to take place.

 The Private System

  • Private health insurance will cover hospital accommodation, some or all of the fees for your obstetrican and paediatrician, and possibly some of the fees for using a private midwife. A lot will depend on your policy so you’ll need to take a close look at this to see exactly what you’re covered for.
  • Unlike in the public system, you can expect some out-of-pocket costs if you choose to use a private hospital during your pregnancy and for giving birth. Out-of-hospital expenses are not usually covered by health insurance, this includes appointments with your obstetrician, fees for an anaesthetist, tests/scans during your pregnancy and Intensive Care fees if you or your baby become seriously unwell during or after delivery. Obstetrician fees are likely to be your biggest out-of-pocket expense.
  • You can select your obstetrician but you won’t necessarily have complete freedom of choice. When booking into a private hospital, you have two options: a) to select a private hospital and choose an obstetrician who attends there, or b) to choose an obstetrician and book into a hospital that they attend.
  • In some cases, you may be required to use a private hospital that has been approved by your health fund. This could have a big impact on your choice of obstetrician.
  • It’s wise to ask for confirmation of what you could expect to pay if the birth does not go as smoothly as you’d hoped or if your baby needs to be admitted to hospital. These type of unexpected scenarios could add significantly to the overall bill.
  • You are much more likely to be allocated a single room when staying in a private hospital and your partner will often be able to stay with you. As a private patient in a public hospital, you will have high priority for a single room but there are no guarantees that one will become available.
  • A midwife will usually be present throughout the birth. Your obstetrican will be on hand (unless they are unavailable at the time that you go into labour) and will visit you after the birth but will not necessarily be with you during delivery. You may not have previously met the midwife before the birth and can expect several staff changes during the birth. For guaranteed continuity of care, you can choose to hire a private midwife but this will add extra to the bill.

How does this play out in reality? We asked Australian mums for their experiences in either the public or private health care systems. Here’s what they had to say!

Aanika at The Active Mum

When we were getting ready to start a family, it was very important to my husband and I that we were able to choose an Obstetrician we liked and felt that we could trust to look after both myself and our babies.  Top private health insurance can be expensive but we made it a priority in our budget and in the early days, we most likely missed out on other things in order to be able to afford it.

We are very thankful that we made that decision as we were extremely happy with the level of care we received by both our obstetrician and the private hospital.  I ended up having to have C-sections for both of my deliveries, so it was very comforting to have my own doctor able to perform them.   I was able to stay in hospital for a full five days after each C-section, in a private, comfortable room with friendly nurses caring for me and my children.  I had a few little complications with each of my pregnancies that could have been dangerous to my babies and myself, so having a doctor that knew my history was incredibly important and helped maintain our health and safety in those situations.

If we ever decided to have more children, we would definitely be choosing to use the private health system again.

I had my first child through the public system. We fell pregnant quickly and our health cover waiting period hadn’t quite kicked in. The service through the public hospital was fantastic and I had a very positive birth experience. Because of that, we chose to use the public system again when I had my second child. Sadly, our second son died suddenly and unexpectedly when he was only two weeks old.

When I fell pregnant again, I was extremely anxious and felt that I needed more reassurance that the public system could offer. I saw a wonderful obstetrician under the private model. The birth experience itself was quite similar between public and private – the care I received was faultless in both instances.

The pre-natal care was very different. Under the public model I never saw the same midwife twice. I often waited up to an hour for my appointment, which was then generally hurried through. My pregnancies were completely uncomplicated, so this wasn’t really an issue but I certainly didn’t get a chance to develop a relationship with any of my pregnancy caretakers. Under the private system, I saw my obstetrician on a monthly and, towards the end of the pregnancy, weekly basis. We developed a relationship and he was very sensitive to my situation. He offered me scans whenever I wanted them and buckets of reassurance. He gave me his personal mobile number and when I was feeling incredibly stressed about my pregnancy, he was open to inducing labour at 37 weeks.

I think we are fortunate to have such wonderful medical care available under both the private and the public models, but for any anxious or complicated pregnancies, I would definitely recommend the private system. If that isn’t an option due to cost, a shared care model with your GP can offer that solid relationship and support that can be so important during pregnancy.

I gave birth to all of my six children in the public health system. My only out of pocket expense was my 12 week ultrasound in later pregnancies, which was no longer covered by the public system. I had one child naturally, followed by five C-section deliveries.

While each birth was different and all had their pros and cons, my preference for the public system was a fine choice for me. During the course of my pregnancies I was able to see many different midwives or I could settle for just a few. I liked this model of care as I always felt my medical state was thoroughly monitored and quite safe; something that’s important to an expectant Mum!

Sometimes I was in a multi-ward during my hospital stay and other times, I was lucky enough to have a private room, which was lovely. I wouldn’t hesitate to return to a public hospital service if I were to continue having children. I felt safe and protected under our wonderful health care system.

Kristy at Lou Lou Zoo

My pregnancy and birth care for both my daughters was through the private healthcare system. Seeing the same doctor throughout both pregnancies was fantastic, it allowed me to become really comfortable with my specialist and I felt like I was in safe hands. My hospital experience was just as positive, with the midwives and staff providing me with such great care during birth and after! If we chose to have another baby, I would definitely take the private option again.

Robyn at Mrs D Plus 3

I have had three children and had a different hospital experience with each.  My first two were born in the NHS system in a UK hospital and my third was born in a private hospital in Sydney.  Although the care was very good for all three of them, there was a clear difference between public and private.  The extra attentions to detail and care that I received in the private system really blew me away.  If money was not an option and I had the choice, I would most definitely go private again.

Kirsty at My Home Truths

As a mother of three, I had various experiences with pregnancy and post-natal care in both public and private hospitals. My first two children were delivered in the public system while I had my third under the care of an obstetrician in a private hospital. If money was no object I would certainly use the private system again as it was a more personal and supportive experience. Having the care of the same obstetrician during my pregnancy was very reassuring and knowing she would be there for the birth gave me confidence as I had had two traumatic births beforehand. I was also able to access consistent and specialist lactation advice which allowed me to breastfeed for a little longer than I had been able to previously.

I do want to note that as a country we are so lucky to have the public system there to support all women and they were there for me when my middle daughter was born premature and requiring neonatal intensive care. However, in my experience, public hospital maternity wards and facilities are under-resourced and not quite as supportive as private hospital units, particularly in important aspects such as breastfeeding support and post-natal mental health. It is definitely harder to make meaningful relationships and gain confidence and trust in a revolving roster of nurses and specialists who don’t always provide consistency in advice.

Amanda at Real Mums

During my first pregnancy it had never occurred to me to be giving birth anywhere but a hospital. To be honest, I hadn’t really thought about it.

The idea of health insurance for pregnancy and birth wasn’t top of mind either; I was fit, healthy, prepared and I didn’t anticipate any problems with either the pregnancy or the birth.

We did, however, have a level of hospital cover for both. It is something I am extremely grateful for. Mostly, I liked the consistency in the obstetrician I was seeing. Seeing the same person each appointment, and the familiarity was something that helped keep me calm and relaxed (although I would also stress that if you don’t “click” with your Ob, go find another one).

He also got to know my concerns, anxieties, and likes, which enable him to manage the birth component of my pregnancy, for which I am most thankful for. The birth did not go well and resulted in an emergency C-section, and having that familiar face, who knew my worries, and whom had provided me with a consistent manner the previous 9 months helped me in that moment.

I was also afforded the full almost week long stay in a private room; with a large family of in-laws, this was more of a benefit to others than myself, but it also allowed me the opportunity to deal with the emotional trauma of the birth in a quiet space.

Although I have great respect for the public system, for me personally seeing the same person throughout was what put me at the greatest ease. The rest was all just a bonus.

My first birth experience was through the public system. At the time, we did not have private health insurance and it was an expense we did not feel was necessary at the time. The waiting times for appointments could be lengthy sometimes, however all the doctors and midwives I saw from pregnancy to post birth were wonderful and supportive, with the benefit of bringing different expertise than a single midwife throughout would have offered.

We are now due for baby #2 in a couple of months and while we have private health insurance, we chose not to go for full pregnancy cover, again going through the public system. While the appeal of a private room is there for private cover, that is the only benefit that we feel we are lacking with the public system. Out of pocket expenses in the public system are much less and as a mostly stay at home mum these days, less spending is preferred.

We have made one change this time, with our share care services provided through a private midwifery program linked to the hospital rather than the GP. The out of pockets after the Medicare rebate are still lower than the GP and the specialised care is much better. If finances were not an issue, going through their complete birthing program would be preferred over either a public or private hospital.

Mums Take 5
Bel at Mums Take 5

I had a child in a public hospital,  which I couldn’t fault at all. I had got to meet lots of the doctors and midwives at my hospital check ups during pregnancy, there were lots of free classes that you could attend, you could do a tour of the hospital before hand and there seemed to be lots of staff available.  There was a private bathroom for that room so I was lucky enough not to have to share.

In a private hospital I only had my obstetrician to consult and although I trusted him completely, I did enjoy the conversation and opinions of diversity that I got from the public system.  Having your own Obstetrician has its benefits-  if I needed an unscheduled appointment, it was done asap (when he wasn’t actually delivering babies) and he was available to consult and knew me and my pregnancy thoroughly.  I felt completely at peace and reassured that he knew what he was doing and we were in complete care  whereas the public system is a bit luck of the draw when you actually give birth.  The midwives although there seemed fewer in number but I seemed to have the same midwives call on me their whole shift so although there was less, it was the same person throughout.  I don’t remember the same free services and classes being available in the private system but the hospital was more private and quiet and it certainly felt more comfortable.  I had a fridge and larger room and bathroom. I did have to take my baby to nursing quarters to bath and although that was great that the midwives were there to assist if you needed it  did prefer the bonding moment with my baby that I had when bathing in my room.

I had a positive experience in both systems.  I felt cared for in both systems and it would just be a reassurance of staff and doctors that I would tend to go private again.  Although I don’t intend to have another, if I did I would go private again just so it didn’t cross my mind to worry who was going to be there and the peace and quiet of the private hospital is worth it as I know too well that the peace and quiet is never like that again when you get home!

For both my babies I went through a birth centre in a public hospital and had wonderful care by a small team of midwives both times. Birth Centre care differs from the usual public hospital model in that the focus is on a natural birth under the care of known midwives in a homely environment, but with all the medical care of the normal birth suites just down the hallway.With my first birth I needed to be transferred to the birth suites, but my birth centre midwife was with me the whole way through which was a great comfort to me. My second birth was very straight forward and I was able to stay in my birth centre room throughout and after both my births, my husband and I were able to bond with our baby in the queen size bed with our baby. It was amazing to receive this level of care with no out of pocket expenses.Another advantage of the public system for me was the care available, free of charge, for my son when it was found he had facial paralysis on the right side of his face a few hours birth. This needed further investigation by a number of different specialists, including a neurologist, ophthalmologist and physiotherapists. These specialists were able to visit from the nearby children?s hospital and after we were discharged we continued to see these specialists regularly, again at no cost to us. It was a very stressful time, but I am grateful for the care we received through the public system. If we went through a private hospital there would have been significant out of pocket expenses, which would have been added stress to an already difficult time.

Disclaimer: The above information is correct and current at the time of publication.

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