Hi there,
I'm currently planning a pregnancy with the wifey and done a lot of reading online regarding whether or not private health insurance for obstetrics is worth it and was wondering if I could get the wider opinion?
From what I've read so far general consensus is that public is just as good but free, rather than pay at least ~$3,000 in gap fees for private.
Thoughts?
Thank you in advance
Edit: Live in WA if that helps anyone with a response, thanks again for all of the responses so far!
Thanks for sharing your experiences! :)
That third option sounds pretty hairy to me.
Hahaha opps
If you want an elective Caesarean in a hotel-like hospital room, and can afford the out of pocket, go with private (assuming low risk pregnancy).
If you want a healthy mother/baby and don't care about the birth 'experience', your local public hospital for free.
If you want a 'natural' birth where the mother has agency and/or are concerned about interventions, choose a hospital with a 'birthing centre' run by midwives for free, but you need to investigate early as they are in high demand.
They are all safe choices, but people tend to have strong opinions one way or another.
What you shouldn't try to do is force a square peg into a round hole. You can't, for example, try and make the local hospital abandon their protocols to favour your desire for a more natural birth, and while private OBs will pay lip service to accommodate your wishes, they will induce you at the drop of a hat if your due date might interfere with a golf game they have scheduled.
Almost everyone I have spoken to who was unhappy with their childbirth has tried to go against the 3 choices at the top and found that when push comes to shove (*) you get what they want to deliver (*).
*apologies for these puns.
Nice summation mskeggs
Four kids in (NHS public, Medicare RPA birth centre, Medicare local country hospital midwife team & at home with private midwife) we've more experience of the differences.
My partner also became a midwife and works in the public system. I have way too many conversations about birth in my life.
Thanks for sharing your experience!
Wouldn't the cost go even higher if pregnancy has complications and opted for private with multiple visits to other specialists besides obstetrician?. In my experience private hospitals are overrated for what it is.
That was our experience… But I've heard it can be hospital dependent, first baby we had a private room in a Public Hospital and the only difference from my outsider's perspective to my sister's Private Room was that she had (hospital grade) carpet on the floors, we had vinyl.
Second time around we had a shared room, but their baby was in ICU, so the other mother was in the room to sleep and eat only.
Also it's not just $3000 in Gap fees, it's also the thousands you pay for Private Health in the lead up to (waiting period) and during the pregnancy…
Realistically you're down at least $5-6000 and that's assuming you get pregnant quick…if it takes you 12 months to get pregnant, not at all unlikely, add another year's worth of Private Health (with maternity cover) to the bottom line.
Whether that's worth it to you or not is really your and your wife's decision.
Public is pretty barebones in terms of comforts - no carpet on the floor, fair chance of sharing a room with another couple, but the medical care is as good or better than private (guess where all the Private patients with complications end up?).
Public kick you out on the street as soon as the baby and mother are deemed healthy enough, wheras Private tend to boot you out to a hotel for a few nights.
It's arguable whether going to a hotel is better than just going home, personally I'd prefer going home… it's scary getting home with a new baby supplied to you without an instruction manual, but you've gotta do it at some stage.
Nothing prepares you for that moment you step back into your house for the first time with the new baby.
Um, what do we do now? Where is that little clear perspex trolley to put the baby in?. Hahaha, happy memories
Yep.. even more surprising second time around when you realise that you've forgotten it all!
Depends on your local public hospital. Read reviews online to try and get an idea.
Also, September is usually high season, so if possible, avoid that due date (whichever way you go).
As @John Kimble says, check the reviews/feedback/wild rumours for nearby hospitals. Plenty of horror stories about Doctors/Midwives who claimed to be "open to options" but were actually determined to do what they wanted; either Caesarian when not required or "natural" birth when not safe for the mother. :(
Have gone private ob - private hospital for our two kids and will do the same for third. Comparing with friends who have gone public, other than the differences in hospital the other benefits are basically 24/7 contactable doctor, and having consistency of this through the pregnancy - dont underestimate this if you might be higher risk. Likewise with my wifes first pregnancy, we were overseas and could email the doctor with any queries at any time.
Also each visit you have to the private OB clinic you also get an ultrasound done, and it cost us about $5 out-of-pocket after medicare for each visit. I know my SIL in the public system only had 2-3 ultrasounds for her whole pregnancy, whereas we had probably 12. A friend of mine lost a child in pregnancy due to complications that would have been picked up earlier by more consistent ultrasounds - I dont think you could have fixed her issue, but for her next preganancy she went from public to private only because of this.
Be aware that not all private ob are the same cost, and ours offers cheaper rates for each birth - I think we paid $1500 first, then $1000 second and not sure on third. I know some other hospitals/OBs charge $3-5k though. Yes there is a 12 month wait list on private health to use the obstetrics, but its not like you wont have any private health at all, just maybe not the same level of cover.
This! If your high risk due to a preexisting medical condition/high BMI then private is worth paying for.
Can also be age-related, there seems to be so many conditions that are affected by pregnancy. You can also develop conditions during the pregnancy (e.g. thyroidism, gestational diabetes) that are easier to keep in check with consistent visits to the same OB.
That said, both my kids were relatively low risk, and came out with natural births with no pain killers, and high APGAR scores, so I could have gone public and saved myself a few grand. But like health insurance itself, it was more of a peace of mind thing in case of any issues and had very little to do with how nice the hospital room was, or getting an individual suite.
I cringe a bit when people baulk about pregnancy fees but are happy to spend $5-10k on more superficial things like high end prams & capsule systems, cots/cribs/bassinets, baby clothes, etc.
Can you be sure up-front how much it will cost though? That's what worries me about private, "unexpected" expenses. But then I don't understand the designer baby stuff either.
@lupiter: Unless something unexpected occurs there won't be any unexpected expenses. E.g. if you need an emergency C-section, there might be the additional cost of the anesthetist, but the OB's cost should be fixed.
How much depends on OB's cost and private insurance additional premium (see below for our example).
@lupiter: ring the OB you want to see and find out what their fees are. One OB we enquired with wanted about $4000 at 20 weeks plus $80 out of pocket for fortnightly appointments prior to this. Plus she had 35+ plus years experience. Another doctor wanted only $2000 payment at 20 weeks but was overseas trained but had plenty of Australian experience and happy & healthy mums & bubs
Get health insurance without an excess so that is one less payment that has to be made.
I agree. Private tend to spend the extra time to answer your concerns and explain in more layman terms. I find public specialists have very few words in their vocabulary. Public hospitals you would spend nearly all the time with midwife. Rather than the doctor. That's fine assuming everything is simple and runs smoothly.
My wife initially was adamant she wanted her own OB and a private hospital. However, after reading really good reviews on the staff and facilities at the local public hospital (which was renovated in the last few years) and hearing from friends how hit and miss OBs and going private can be, completely backflipped and we went public. The young female doctor we had could have improved her bedside manner, but apart from that the midwives and facilities were great.
Also, highly recommend you both doing a calmbirth course if there is one near you (although the closest one appears to be Margaret River?)/you can afford it (most private health insurance should give you some back anyway).
All the best!
I feel asleep each time the instructor did the calming talk.
Maybe they should rename it "asleepbirth"?
We've been private insurance and private hospital.
To give you indication of costs: the OB's cost is around $6k and the extra premium for top hospital cover to cover the stay in hospital is around $2k (12 month waiting period; obviously you need to try to optimise how long you're on top hospital cover, but don't cut it too fine). For our last stay, the health fund paid around $6k for our hospital stay (if I remember correctly). This was one of the top North Shore hospitals.
Did we need all this? Apparently some of the OB's that charge $6k in a private hospital are on call in the nearby public hospital and supervise the young OB's anyway, and although the food in a private hospital is much better, it's a big outlay.
At the end of the day, it's the cost of peace of mind for the mother delivering. The wife just attended a baby shower and it seems professional mothers tend to not to be too worried about OB/private hospital costs. As an OZB husband, remember: happy wife, happy life.
In terms of anything like what might be considered a "typical birth", i.e. 80%+ of cases (probably more), the choice is simply one of personal preference.
The public system and private system provide the same level of care (it's all subject to the same level of government regulation).
The public system will be a more bare bones experience … less staff, shared rooms, shorter period in hospital, fewer classes, more basic facilities/amenities, etc. It won't change the overall level of medical care afforded.
The private system will provide you with trimmings … greater staff availability at all stages, private rooms, longer stay, common areas away from the actual room, etc., etc. We went down the private route and my wife on both occasions had something that was more like a large hotel room with a double bed, lounge, coffee table, etc. Could easily accommodate a number of visitors without everyone being crammed in or taking turns cycling through the waiting room.
As others have mentioned, if something significant arises, you'll likely find yourself at a major public hospital in any event.
As noted, the choice is a personal one based on the sort of experience you are looking for.
staffing is never better in private hospitals in any situation.
We could have afforded private but chose to go public (Monash) for both our kids and don't regret it.
And if something major goes wrong I know where I would rather be
No private health insurance - pubic hospital??
One trick if you go private for the birth - if the kid needs to go to ICU do not agree to private insurance to cover that. The experience is identical and you dont care about dr choice at this stage.
If they ask for insurance details just say Medicare (they will give you a guilt trip about burdening the health system).
Can you still go public if you know well in advance that you have to have a c-section? I.e natural birth isn't an option
Yes public will book you as elective c section if a normal vaginal is contraindicated. People can even push for elective c section in the public if they go hard enough (anxiety can be enough)
i would suggest find a good shared care gp
They will cover your antenatal care all through the pregnancy with a few hospital midwife appointments. That gives you the continuity of care you want.
Note that even if you pay for a private obstetrician
1. They may not do the birth. Baby comes when it comes and they don't block out a month of their schedule to wait for your birth
2. There's a well known argument that private obstetricians are quicker to rush to c section. I've seen from the inside that this is the case. If you're not that keen on this possibility then think twice.
I can't see a single argument for wasting the money on a private obstetrician. A public hospital will provide plenty of complex care needs, for free
Another thing to be aware of is your planned obstetrician's C-section rates. If you want to space future pregnancies close together you have to have the best chance of a vaginal birth for the first one, and the public system offers a much higher chance of this (from memory 78% vs less than half in the private system).
DOI am a doctor who delivered 3x in the public system. If things go wrong you want the neonatal resuscitation team a short sprint down the corridor not 25 minutes drive which was the main reason for my decision (I'm also in WA). Having had 2 normal pregnancies I needed emergency CS for the 3rd, "low risk" is a postnatal diagnosis.
I've never tried public for my both children but I must say I am satisfied with my obs and the hospital stay. I had c section for both. Recovery was good and happy with the stitches.
I had my first child in a private hospital (westmead private) last year. I don't think there will be much difference in terms of doctor expertise etc but what I did find helpful compared to my friends who went public was the aftercare. In public once they make sure you are all healthy they will send you home. At private you can stay up to 4 days. This 4 days at hospital was invaluable for me as a first time mum. I was able to go to the breastfeeding clinic everytime I needed to feed the baby so they could show me what I was doing wrong or encourage me by telling me I was doing it right. I could call on the nurses for help when I wasn't sure what to do. (you still get breastfeeding clinic help at public but I was told you have to make an appointment and they come to your house, this means at the time I would really need advice… They wouldn't be there).
So in summary, if you can afford it, I would definitely recommend private for first child. (once you know what to do and are more confident I would consider public)
Thanks so much for your comment my wife is keen to do the same thing :)
You are already doing great as a first time parent. From conception onwards, you will do everything in your own power to put their needs first.
It's scary and you worry about everything but it's the most amazing and rewarding thing to watch your small one grow. It really is the best gift ever. Good luck and no matter what happens you will find a way.
Thanks so much for your kind comments and share! :)
I did a LOT of research on this and would go private every day of the week.
Why? Level of care is much higher with greater attention to detail. Public is fine if you have a low risk no issue pregnancy. The problem is you don't know what kind of pregnancy you might have. And god forbid if you have a miscarriage or major pregnancy issue….the stories I got told of women experiencing miscarriages in public hospital emergency department toilets or alone at home with no one to call for advice. Horrific. If your have private you can get your OB on the phone at 3am. If necessary, you will be in that first appointment at 8am the following day and if any procedures need to take place, you will be at the front of the queue. Good luck having that kind of speed in a public hospital….unless you are about to die, you WILL be waiting.
In private, you have staff who are so highly trained and experienced their level of care goes above and beyond to make sure you are ok. There is a standard of thoughtfulness and finesse that I've not seen in the public system. Don't underestimate the importance of this if you are having a tough time physically or emotionally.
You will have your own private room in private. Imagine you've had a bad labor…maybe you ended up having an emergency c section or some other issues occurred. Do you want to be sharing a shared room for 2 days with a prostitute druggie feral in a public hospital? Happened to my SIL.
At first I thought WTH I'm laying minimum $6k for an OB who might not even be the one to deliver my baby. But when something goes wrong you realize it's the best money you ever spent and you would not think twice about it ever again.
If you can afford it, do it.
I am pleased you did some research on this, but you should note you conclusions are not correct.
The public system has excellent outcomes, amongst the best in the world.
The private system has an elevated level of interventions with the medical complications they bring, including more c-sections with the attendant risks of all major surgeries.
You will also note that the country is literally covered in public hospitals, available 24/7 should you require emergency care - you aren't reliant on getting in contact with a single OB that might be tied up with another patient.
A shared ward will mean that other patients are in the same room. If the priority is a private room, a private hospital might be a suitable choice, but trying to cloud the issue with suggestions medical care is wanting in the public system is untrue.
There are very comprehensive statistics available that drill down to individual hospital level.
This would be a good starting point for comparison.
http://www.healthstats.nsw.gov.au/Indicator/mab_bth_cat/mab_…
I have to comment on your elevated level of interventions - that is a consequence of the private system itself. If you choose to have a caesarean or if you want to be induced prior to 40 weeks, odds are that you are going to be private as no public OB will want to do this based on your choice. The studies back this up with a ~28% of public births are C-section compared to ~43% in private. No private patients are likely to wait until 41 weeks until wanting to be induced either, with public hospitals
You will also find that private has a higher percentage of pain relief than public - once again, if you are paying for the birth you are more likely to demand what you want and when.
What I am getting at is that this is not a statistic that you can infer reflects on the care or risk of the treatment within a private hospital - the elevated intervention is due to the patients and their expectations not the system. Its about as correct as me saying the public system doesnt give out pain relief because it costs money and they dont care about their patients.
I understand your comments, additional interventions are often either requested or welcomed.
I do take issue with the idea: "if you are paying for the birth you are more likely to demand what you want and when."
It is a bit short sighted, I think, to request major surgery (a Caesarean) and a bit problematic that doctors who are paid more demonstrate a 10-15% higher rate in producing them. I would have assumed that a medically advisable intervention would occur at the same rate despite how doctors are remunerated, but that isn't the case. I'll go on record to say I believe that is because privately funded OBs are compromised by the financial rewards of providing what their fee paying patients want, and are performing unnecessary procedures. And the higher rate of intervention is against best practice for the WHO and our government health guidelines. I would suggest that it doesn't deliver better health outcomes or better efficiencies.
But in the same way I am not particularly upset about people getting plastic surgery or other unnecessary medical treatment if they pay for it, it isn't really my concern (well, except that I subsidise this waste through a 30% tax payer subsidy fo private health insurance, plus additional tax penalties if you earn more or are over 30, so I do feel it is problematic).
I do agree there is a high amount of self selection. Remote and low income people, who are disproportionately represented in most negative health statistics are almost absent from private hospital stats. Wealthy, older mothers are largely over represented. Each have risk factors that no doubt lead to a bunch of interventions.
My own bias is toward fewer interventions, so you can see I will be supportive of public hospitals in general, and particularly birth centres.
But regardless of my personal bias, it is important to call out misinformation that claims public hospitals are 'horrific' or "women experiencing miscarriages in public hospital emergency department toilets or alone at home" as something that is acceptable or anything except a terrible rare event.
I also note that pain intervention is readily offered and in no way rationed in the public system, the lower rates of use are a result of maternal choice (and also that increased pain medication is correlated to increased interventions).
I strongly believe we have an obligation to promote high quality public health, and untrue comments designed to breed fear in people are destructive to the cohesiveness of our society. So I promote the stats and facts as a good way of showing they aren't reflective of reality.
Just wondering, would you have any data for Victorian public/private hospitals?
I'm interested in the statistics for birth outcomes & interventions.
Also, based on your knowledge - would there be any particular situations that come to mind where additional tests/checks/procedures conducted with private cover pre-natal that lead to better birth outcomes vs going public?
Like OP, wifey and I are also planning first pregnancy in the near future - no idea if we will be considered low or high risk. Wifey would be ~33-34 years old at the time or older if it takes longer to happen.
Greatly appreciate any further thoughts.
For stats, try here:
https://www2.health.vic.gov.au/hospitals-and-health-services…
Bear in mind that there is a strong correlation between wealth and health outcomes, so hospitals getting poorer outcomes in disadvantaged areas versus those getting good outcomes in prosperous areas does not necessarily indicate differences in the quality of care.
I'm not a clinician, and I don't have any expertise in assessing medical statistics. I am interested in patient centred care (I think patients should have the right to choose care, even if a paternalistic clinician would recommend otherwise).
There are many things that might impact your partner's maternal risks besides age, e.g. obesity, blood pressure, diabetes, drug use etc.
Generally speaking, my conclusion is there is too much intervention, rather than too little, in both public and private systems. By which, I mean, consider if you monitor your blood pressure every hour. It is quite likely that over thousands of measurements, you will detect one or two anomalous readings that suggest your pressure was a bit low or high.
Would it make sense then, for you to start taking medication, alter your diet etc. because of this very infrequent anomaly? Most people would say no.
Similarly, in the private health system (and increasingly in the public system too), the answer to any ante natal concern seems to be to recommend major surgery. This simplifies decision making for all concerned, and removes the randomness inherent with biological processes like natural onset of labour. The down side is some people die in surgery (very, very, very few) and everyone has substantial recovery periods and need for pain medications, but from a clinician's point of view those are all understandable and predictable. They just need to keep improving the process and risk management to keep reducing problems.
For some people, this approach is sensible. They already watch for the latest research into what foods cause cancer today, and what levels of carbs or gluten is recommended. They feel that life is a risk that their body is ill prepared to face, and they must constantly intervene to maximise their chances of living.
Other people take an unhealthy alternative, eat what they want, fail to exercise, drink, smoke etc. with impunity. They assume that their health will likely be OK, at least in the immediate future.
Most people are more balanced, avoiding unhealthy behaviours but not to a ridiculous degree, treating actual health complaints, but not trying to diagnose every occasional ache or pain.
From what I have seen (and the stats), a private hospital aligns with methods of care that place care in the hand of a obstetric surgeon, with the consequent high level of intervention, with lots of monitoring and a high likelihood of a surgical delivery.
Public hospitals will generally have midwives managing the birth of normal risk women. There are different programmes - the usual has midwives reviewing pregnancy progress regularly via outpatient clinics then the midwives on shift attend the birth, with obstetric and paediatric care on call or for an escalation.
Other models (case load or continuity) assign you a midwife that is consistent throughout pregnancy and will attend the birth. This has the advantage that you get to know your carer and can establish rapport etc. but they can be hard to get access to.
Both vary in setting, either in a hospital maternity ward, or a birth centre (which is more like a motel room that a hospital).
My conclusion is the optimum care is via medical staff who want you to have a natural childbirth unless you have medical risks that necessitate intervention, and that prioritise patient outcomes over systemic efficiency (e.g. take your time, not inject hormones to speed up labour). The best path for this is likely allocated midwife care, ideally in a birth centre.
You might be different, taking a range of vitamins and supplements everyday and want the reassurance of an obstetrician performing surgery to remove uncertainties.
There is almost no statistical difference, and literally one fatality a year can tip the stats one way or another, negative outcomes are so infrequent.
What I have seen that is problematic, is people deciding on a path(or not deciding, and just being shunted into mainstream) without considering what is best for them, due to family or friends or GPs telling them what they think.
If you don't actively think about it and make some decisions yourself, there will be a medical administrator somewhere who has set the most 'efficient' channel for people who don't care, and in my opinion, this is set up for the benefit of the hospital rather than the patient where their interests conflict.
In any case, maternity care in Australia is outstanding at all levels, so you have little to worry about in terms of medical outcomes, just how you get from here to there.
One last comment from me as a man, is that before I had a child, I thought outcomes were all that matters. After all, what is a bit of temporary discomfort etc. in the scheme of things? I have since found that the process is extremely important to the majority of women, and failure to consider this can have lasting repercussions that I wouldn't have considered like almost PTSD (and I think in some dreadful cases, actual PTSD) or problems around self esteem, or increased incidence of depression or anxiety. So I suggest it is something worthy of spending a bit of energy getting the right path for you.
I'm in WA and haven't had to make the decision yet. My decision would most certainly be impacted by the public hospital that I'd be likely to attend. There are catchment areas, but if your pregnancy is high risk you're likely to be referred to King Edward. I have heard positive things about Kind Eddies, but very negative things about Osborne Park hospital for example.
My wife and I had 3 kids with no health insurance via public. No problems at all. Our first 2 were born at Wodonga hospital where we were given a private room as they weren't busy.
My sister in law wanted private when having her first - her Dr was busy when she went into labour and so some other Dr observed. She went public for the next two. Her observation was that there was no difference in service between the two.