The Future of Private Obstetrics: A Work in Progress

Dear Colleagues,

We are now well into 2021 and our energies so far have been focussed on the emerging threat of managed care in medicine generally but in obstetrics particularly and the current parlous state of the entire private obstetric sector.

The Federal Government has resumed work in this important area and reaffirmed their commitment to working with the profession on boosting the number of women accessing private obstetric care and keeping the sector alive.

In late December 2020, the Department of Health requested further follow up to the Discussion Paper circulated in July and a Stakeholder meeting is now scheduled for early March.

It is important to appreciate that the Government motivation is very much to take increasing pressure off the public health maternity units and to facilitate this by encouraging women back into the private system.  In addition, it is in the department’s interests to ensure emerging generations of doctors see obstetrics as a viable career and continue to apply to become registrars who are the backbone of the public hospital workforce in meeting service delivery demands.

College data suggests that greater than 70% of fellows work in the private sector once they have finished training and if this sector continues to shrink, there will be fewer places for fellows to go and ultimately this will result in fewer doctors choosing obstetrics as a career leading to worsening shortages, not just maldistribution. 

MBS data shows that in 2019/20, 46% of women who had an initial consultation with an obstetrician did not pursue private obstetric care. This is a significant increase from the seven years to 2016/17, where on average 12% of women did not pursue care with a private obstetrician.

It is acknowledged that their reasons have not been surveyed, but it is widely assumed that  the impact of perceived (or real) Out-of-Pocket costs for a private birth has driven more women into the public system, even if they carry Gold level private health insurance.

NASOG has taken the lead in trying to provide a workable solution to this dilemma and is representing the profession in discussions with the appropriate department decision makers.

Taking into consideration feedback from our member survey in mid-2020, as well as the MBS data, we have sent an initial proposal to Government that would see (directly or indirectly) an increase in MBS rebates or other methods to reimburse patient costs. The approach is aimed at directly targeting those 46% of women who are currently deciding not to proceed with private obstetric care.

A key component of our proposed solution is that it places no obligation on any individual practitioner to change the way they practice or undertake their billing, unless they choose to do so.

This means that those doctors who are satisfied with the status quo and feel the system is working well with their current patient levels and income can stay as they are but those who for whatever reason want to, have the ability for their patients to access a new range of rebates.

By agreeing to use this system, doctors would charge a fee that would attract larger rebates leading ideally, to little or no patient  out of pocket costs.

It is important to point out that this would not involve signing contracts with health funds or hospitals and the doctor’s autonomy would be preserved.

It is still early days and there is considerable work to do before a workable solution that satisfies all parties is put in place. The Government appears to have a genuine commitment to address the crisis in private obstetrics and the Department of Health is working with NASOG in a true spirit of cooperation, looking for a mutually acceptable solution.

NASOG is determined to make a real difference to private obstetrics in Australia and secure a future career for existing and future members. This a key time to gather the support of the profession so please let your colleagues know that they can help by becoming a full member or supporter of NASOG. The more members we have, the louder our voice becomes and the more impact we can have on policy outcomes.

A/Prof Gino Pecoraro, President

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