Public vs Private CareIt is that time of year when health funds are about to increase their premiums. This year’s increase thankfully is quite modest. It is the least increase in nearly two decades. The average private health insurance premium will increase by 3.95% from 1st April 2018.

There is a lot in the media about which health fund to choose and indeed whether to be in a health fund. With all the other household financial pressures some people are considering opting out of their health fund and be a public patient instead of a private patient for pregnancy care. This decision is compounded by anecdotal stories about significant out of pocket costs when being managed as a private patient.

My wife Robyn had lunch the other day with a friend. The friend told her about the horrific labour and childbirth experience of her daughter as a public patient. The crazy thing was this lady’s daughter was privately insured. Her daughter’s sister-in-law told her she should go public to have her baby as there would still be considerable out of pocket expenses if she went private, and that her pregnancy, labour and delivery care would be free if she went public. She took her sister-in-law’s advice. My wife’s friend said because of her bad experience as a public patient next time her daughter won’t be listening to her sister-in-law.

The previous week I had three patients see me for an initial visit who had bad labour and childbirth experiences in their previous pregnancies as public patients. One transferred to my care from the public system at 30 weeks of her current pregnancy. The second did this at 12 weeks of her current pregnancy. The third is not yet pregnant. She and her husband wanted to discuss her last pregnancy management (as a public patient) and to plan the next pregnancy management with me being her private obstetrician. I see a lot of new pregnancy patients who were public in their previous pregnancy and who now want to be managed as a private under my care for their second pregnancy care because of problems and complications that occurred in their first pregnancy which they attribute to having been a public patient.

What will the financial pressures, gaps to pay, not knowing the differences between private and public for pregnancy care, stories they read in the media and online and often pressure from family and friends who consider public is good enough and private is too expensive I can understand why to be managed as a public patient for pregnancy care is a tempting option. But while public pregnancy care is free it can become very costly in other ways, if there is a complication or something goes wrong which would probably not have happened if management had been as a private patient.

There are lots of differences between public and private. These are considered on my website in the article ‘Public or private – What is the difference?’ The situation will get worse for public patients if there are significant increase numbers of patients booking at public hospitals for pregnancy care because they give up being in a health fund for financial reasons and if there is no more money available in the public health care system to cope with this increased workload. More public patients will result in the differences in the quality of care between private and public care being compounded even more.

I consider the most important difference between private and public is the clinical expertise and experience of the person who is looking after you. Pregnancy complications often occur without any warning in childbirth and can be very dramatic and life-threatening for your baby and/or you. A key question you should ask yourself (that is much more important than financial matters) is: “Does the person who is going to be looking after me and my baby have sufficient training, skills and clinical acumen to appropriately deal with a major complication should there be such an emergency?”  Also remember such crises can occur at any time, including in the early hours of the morning when there is minimal backup staff support.

When considering private pregnancy care I can only comment about myself and my management. There are considerable differences between obstetricians in their patient management, clinical skills, and experience. There will be also considerable differences in fees and out of pocket expenses between private obstetricians.

If you are considering booking with me as a private patient please phone my secretary on 02 9680 3004 or book a free ‘meet and greet’ appointment of detailed information about our fees and your out of pocket costs when booking with me and also about our pregnancy care management. There is information about our pregnancy care management on our website at ‘Highlights of our care of you and your baby’. There is general information about our fees and gaps on our website at ‘Fees’.

I have personally managed over 10,000 pregnancies over several decades. That means I am extremely experienced and highly skilled. My medical practice focus is pregnancy care, with over 90% of patients who book with me being pregnant. My considerable experience and high level of expertise gives me the ability to appropriately deal which a complication should it occur. As well it means that I am often able to anticipate a complication is imminent and respond appropriately to either avoid the complication or minimise the impact it has on your wellbeing or your baby’s wellbeing.

Patients often comment how calm I am even when there is a significant childbirth complication, and as I am calm they don’t need to be stressed. Being calm is a consequence of my considerable experience.

I like to fully explain to a patient and her husband/partner what is happening at all times and especially when there is an adverse development and what measures I am taking to safeguard her and her baby’s wellbeing. Communication is very important. It is much easier for my patent to trust in my decision making as she has booked with me for pregnancy care and I have built up a considerable relationship with her by personally managing her during the pregnancy.

I take your wellbeing and your baby’s well-being very seriously. I often tell a pregnant patient I endeavour to give the quality of care I would give if you were my own daughter. I am extremely careful and diligent. The outworking of this is I have very few significant complications.

In contrast, if you choose to be a public patient you give up the right to have any say in who manages you in pregnancy and in labour and who delivers your baby. The hospital chooses. If it is teaching hospital, then it is likely you will be managed by trainee (or apprentice) midwives and trainee obstetrician (residents and registrars) doctors. Their clinical ability and competence will be in proportion to their experience and level of training. I learnt my clinical skills while practising on public patients, as did all specialist obstetricians.

I was discussing this recently with the husband of a patient who is a senior plumber with apprentice plumbers in his firm. I said it is equivalent to your apprentice attending to the plumbing job rather than you. As well this apprentice attends often unsupervised. Their chances of not getting a good outcome for the client or making a mistake are greater because of the lack of experience of the apprentice plumber. But here we are dealing which human lives (the labouring woman and her baby) and not pipes and is the implications of bad decision making are so much more.

Another comparison is when you get your car serviced the apprentice who does the job, often unsupervised. Or if you go on a flight it is a trainee pilot who is flying the plane, often unsupervised. Would you be concerned? I am sure yes. Then why be satisfied with this same situation when it comes to your wellbeing and your baby’s wellbeing?

When it comes to costs as a public patient, yes there will be ‘out of pocket’ gaps that you will have to budget for. The Medicare rebate in obstetrics is so low that it would be impossible to have a financially viable medical practice without changing gap payments. We have endeavoured to keep out of pocket costs to a level than most people find affordable and reasonable. The ‘out of pocket’  cost for my patients is far less than the amounts a couple of media reports stated were charged by some obstetricians.

For my pregnancy care of you, there are only gaps to pay for your initial antenatal visit and your management fee. Other antenatal visits with me are bulk-billed. We are a ‘no gap practice’ for your delivery and accept what your health fund pays as full payment. I do a 2D, 3D and 4D ultrasound scan of your baby at each visit at no change.

Also see on my website:

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*Saturday morning appointments are not available for initial antenatal visit.