Despite paying for private health insurance for the last four years, Jessica* has no idea who will deliver her baby.
The first-time mother felt assured by the policy’s promise of continuity of care and comforted that the doctor who saw her at the beginning of her pregnancy would be there to deliver her baby when her January due date arrived.
Instead, she discovered there was no private obstetrician to deliver her baby in Lismore, in the northern rivers area of New South Wales.
The city’s only private hospital also has no maternity service, meaning her only private option is to drive almost 150km to the Gold Coast.
“I didn’t want to have to be on the road for an hour and a half if I was to go into spontaneous labour,” she says.
As more private hospitals close their maternity wards, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Ranzcog) says more women like Jessica are facing limited choices in maternity care.
Ranzcog says it is a symptom of the gender bias in the funding for private health services, where procedures for men attract higher rebates.
The peak body says the stoush between private hospitals and health insurers is exacerbating the issue. Hospitals are concerned about the rising costs of providing care and asking insurers to pay more, while insurers argue they are paying hospitals fairly and that consumers with health insurance should not be asked to pay more.
In the meantime, nine private hospitals closed their maternity wards between 2015 and 2023, and two private hospitals with maternity services ceased operating.
Ranzcog says these issues are limiting women’s health choices. The peak body will hold a roundtable on Thursday when the government and industry stakeholders will discuss the future of private obstetrics and gynaecology.
It follows a government review of the private hospital sector’s financial viability which found obstetrics is a service “of concern” and becoming “increasingly difficult to offer”.
Dr Heather Waterfall, Ranzcog’s South Australia and Northern Territory chair, says private insurers, Medicare and private hospitals do not provide women’s health with the same level of funding or support as men’s health.
For example, specialists get paid less to do a more complex ultrasound on a woman than a routine simple scrotal ultrasound on a man. Private hospitals also have limited theatre availability, Waterfall says, and will prioritise the patients of orthopaedic surgeons and urologists who bring in more money because they bring in higher returns.
She has been advised not to book endometrial ablations, a procedure to reduce heavy menstrual bleeding, unless women are insured with two private insurers, because otherwise “it actually loses money for the hospital”.
Because the private health insurers do not pay the private hospitals sufficiently for obstetric and gynaecological services, they are the first to be closed down when the hospital comes under financial pressure, Waterfall says.
The CEO of the Australian Private Hospitals Association, Brett Heffernan, said: “Unfortunately, as the main mechanism for funding services in private hospitals is private health insurance, and as those payments have not kept pace with indexation, some hospitals have had to make the tough decision to close services, or close hospitals.”
But Dr Rachel David, the CEO of Private Healthcare Australia (PHA), which represents the private health insurers, says factors affecting the viability of private maternity services are mostly beyond the insurers’ control.
She points to economic and social factors driving down the birthrate, a limited specialist workforce, and high fees being charged by obstetricians.
“We’re very concerned that if obstetricians are getting fewer patients, they will increase their fees even more to make up for this,” David says. “This is causing a vicious cycle which could eventually end private maternity.”
David says PHA has urged the government to allow health funds to contribute to more affordable, contemporary models of care such as paying midwives and GPs more for their work in private hospitals.
In the meantime, Ranzcog says patients with potentially complex, painful conditions like endometriosis can’t rely on the public health system for care either, which is increasingly showing cracks.
Amber* eventually upgraded her private health insurance after almost two years on the public waitlist for surgery to treat the condition.
After Amber became “absolutely distraught” from the pain she suffered while on the waitlist, her gynaecologist advised her it would be quicker for her to upgrade her private health insurance and wait the 12 month cooling off period. As soon as it ended, she went back to see her gynaecologist. “I said that you were right. I still haven’t moved on the public health system and can I get surgery now?” Amber told them.
Amber was booked two weeks later. She was still $3,000 out of pocket after the surgery, but says she is “hoping that there’s a new chapter on the end of this”.
Ged Kearney, the assistant health minister and chair of the National Women’s Health Advisory Council, will attend Thursday’s roundtable and says: “Whether it in be the public or private system, in health and medical research, or disparities in costs faced by women, there are many ways that gender bias creeps into our healthcare system.”
The government is conducting an audit of the Medicare Benefits Scheme to examine gender-based differences, she says. “For too long women’s health has been ignored and overlooked.”
*First name only used to protect medical privacy.
