Maternity system at ‘crisis’ point

Women giving birth in private hospitals has plunged, forcing hospitals to close maternity wards and pushing an extra 27,000 births a year into public hospitals.

Public hospitals are being swamped as women abandon giving birth in private hospitals. Picture: istock

Exclusive: Women giving birth in the public system are being discharged early and billed hundreds of dollars for ultrasounds that used to be free as maternity services buckle under pressure.

Privately insured mums are shunning private births because they can't afford the $4000-$13,000 out-of-pocket fees charged by obstetricians.

The exorbitant fees have seen public hospitals swamped by an extra 27,000 births a year.

A News Corp Australia investigation has found this has led to serious overcrowding and mums have complained public maternity wards are so understaffed nurses don't answer buzzes, and breastfeeding help is not available.

They also allege:

• Beds aren't changed;

• Bathrooms aren't cleaned;

• One mother, unable to lift her baby after a caesarean, says she had to rely on other new mums in her ward to help with her baby because nurses were too busy.

Women are also being forced to pay $200 for the two routine ultrasounds needed to check on their baby's development. These services were previously provided for free.

Some mums are also being discharged within hours of the birth, others just 24 hours after a caesarean, obstetricians say.

New mums don't fault the professionalism of their medical treatment but say nurses and midwives are too stretched to be able to provide personal care.

At the same time, obstetricians are warning the private maternity system is in crisis, the Medicare rebate for a birth has not been increased for six years and they fear their incomes are under threat as a series of private hospitals shut the doors of their maternity wards.

They have held a series of crisis meetings with health funds, private hospitals and the Chief Medical Officer this year without reaching a solution.

"You've really got to ask yourself about the point of private health insurance when the principal reason families take it out is to have a baby and then they don't use it," Royal Australian College of General Practitioners president Dr Harry Nespolon said.

Alecia Staines, director of Maternity Consumer Network, said mums are also avoiding private hospitals because they are associated with higher rates of Caesareans.

 

The maternity system is in crisis say obstetricians. Picture: istock

Mums want a new maternity care framework due next year to remodel the system so that more women get the option of being assigned a midwife who follows them through their entire pregnancy, birth and after birth care, she said.

NSW Nurses and Midwives' Association assistant general secretary, Judith Kiejda said under the current staffing system, there are no ratios of midwives to mothers, which means midwives can be caring for up to 10 mothers plus their babies at any one time.

"This doesn't allow time for midwives to provide the level of support and education new mothers need. It's not sustainable and it's not fair on families."

The proportion of women giving birth in the private system has plunged from 30 per cent in 2008 to 26 per cent in 2016.

Some women in the public sector can't get their first appointment at the hospital until they are 20 weeks pregnant, Queensland obstetrician Dr Gino Pecoraro says.

Donna Garland, Westmead Hospital women's health director says the free pregnancy ultrasound at her hospital is "limited" and concedes women are referred to private providers.

 

Free private care is no longer available as women pay for ultrasounds. Picture: istock

There has been a nine per cent increase in births at Westmead since 2013 and to manage it, the hospital is offering 600 women a year one-on-one midwifery care during birth and after birth in the home, she said.

Gladstone Mater Hospital in Central Queensland closed its maternity ward on October 1 and earlier this month Healthscope closed the maternity ward at Melbourne's Knox Private Hospital after 130 fewer babies were born over a 12-month period.

Knox Melbourne Hospital is one of the largest private hospitals in Melbourne.

Obstetricians report some of the private hospital maternity wards that are still open are 30 to 50 per cent empty and unless something is done to fix the crisis more private maternity wards will close.

"There becomes a threshold below which it is no longer profitable for private hospitals to have maternity units and birthrates are so low staff are deskilled," Dr Pecoraro said.

Former federal AMA president and obstetrician Dr Andrew Pesce said the fewer private patients obstetricians got, the more they had to increase their fees for each birth to cover the set costs of running their practice and paying for insurance cover.

 

Private hospitals are closing their maternity wards because of a lack of demand. Picture: Getty

Private Healthcare Australian chief Dr Rachel David said health funds had offered to ask for a change to Medicare rules to allow funds to cover $1000 of the cost of out of hospital antenatal visits but obstetricians said it wasn't enough money.

Medibank, one of Australia's largest health funds says the private health industry needs to come together to do more to address out-of-pocket costs.

"We know that some of our customers are experiencing bill shock and are increasingly concerned about large gap payments," Dr Andrew Wilson, Medibank group executive healthcare and strategy spokesman said.

"Key to this is ensuring that there is greater transparency across the sector so that customers know what to expect when they need to use their cover and what out-of-pockets they may have," he said.

"We're helping our customers to make informed choices about their healthcare and have launched a procedure cost estimator on our website. The calculator provides the likelihood of having out-of-pocket costs with an indicative range, and what's paid by Medibank and Medicare," he said.

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