HealthAgenda

Find out the difference between going public and private for pregnancy care – and which might be right for you.

Karen Burge
July 2018

Ideally, the decision to go private or public is something you’ll decide on well before you start trying to fall pregnant.

That’s because if you want to go private, you need to have private hospital cover that includes pregnancy and birth-related services 12 months before the birth of your baby to be able to claim for the services listed on your policy. If you go public, your care will be free.

Weighing up your options can be challenging, particularly if it’s your first pregnancy. You need to consider what kind of medical professional you’d like to lead your care and the place you’d like to give birth in.

Your choice can help create a pregnancy experience that matches your expectations. For example, when it comes to facilities, you might believe labour should have minimal intervention and prefer the home-like feel of a birthing centre.

Or maybe you prefer having pain relief options more easily accessible in a hospital setting.

Birth experiences

For HCF member Monique, a smooth first pregnancy led her to choose public care the second time around.

“I hadn’t chosen an obstetrician for my second baby and decided to go to a midwifery clinic,” she explains. “Coming up to the end of term the baby hadn’t turned and he would have had to be a breach birth. It was recommended that I have a C-section.

“I had to go into hospital not knowing an obstetrician and having to have a procedure [without] knowing the doctor that was doing it.”

For Sydney mum Jessica, falling pregnant before upgrading her policy meant she had little choice but to proceed as a public patient. She’d had great care through a private obstetrician during her first pregnancy and was initially concerned about not having that again.

However, her public hospital experience was very positive, and she felt a warm connection to her small team of midwives throughout pregnancy. Her only downside was sharing a room post-birth, which she found to be uncomfortable, noisy and a little chaotic with the flow of visitors to her room-mate.

Know your options

Find out what local maternity services are on offer, speak to family and friends, and discuss your options with your GP. It’s also a good idea to consider the following questions:

• Do I want a dedicated obstetrician?
• Would I prefer midwifery care?
• Where would I like to give birth (hospital, birth centre, home)?
• Does my local hospital offer a small-team midwifery model of care or will I see different faces each visit?
• How important is it to have my own room after delivery?
• If complications arise, am I comfortable being looked after by doctors who I might not have a relationship with?
• What pain relief options do I want access to?
• How important is having close access to medical intervention or neonatal units?
• Do I want minimal intervention (if possible)?
• What kind of labour do I want (i.e. access to baths, birth pools etc)?
• How much contact would I like to have with my regular GP?
• What can I afford?
• How close to home will my appointments be?

Going private

Having your own obstetrician can be reassuring. You see the same person each visit at their private rooms, they get to know you and your pregnancy and will usually be present for the birth.

Your doctor will provide ongoing care for up to 6 weeks after you give birth. In some cases, they’ll have a midwife on staff who may be involved in some of your appointments and postnatal care.

Going private enables you to choose your doctor and where you give birth. You might take a recommendation from your GP; select a doctor first then your hospital based on where that doctor delivers; or choose a hospital first then a doctor from its list.

HCF has agreements with many private hospitals and has negotiated ‘known-gap or no-gap’ services with doctors across Australia to help minimise your in-hospital out-of-pocket costs.

When you meet with your chosen obstetrician, ask for a detailed breakdown of all costs they can foresee for your pregnancy, birth and postnatal care. This will help you understand what your health insurance will cover, what Medicare rebates you can expect and what your out-of-pocket costs are likely to be (see What isn’t covered below).

To be covered for pregnancy and birth, HCF members need to have an appropriate level of cover (such as the My Family or My Family Plus packages, or Premium Hospital) and have served a 12-month waiting period. If you have extras cover (which the My Family packages include) you’ll also be able to claim for a range of support services, including childbirth education classes, physiotherapy and pregnancy compression garments.

What isn’t covered?

Be clear on what your insurance doesn’t cover. Health funds aren’t able to cover outpatient services like consultations, scans and your obstetrician’s management fee, for instance.

Even when pregnancy and birth services are covered, assisted reproduction like IVF may not be, so it’s important to know what your policy includes from the start. HCF members on Premium Hospital cover can claim for assisted reproduction services.

Going public

Using the public system certainly doesn’t mean you lack choice; there may be many models of care and birth philosophies (depending on where your location) to choose from.

When deciding how you want to give birth, you might like to tour the hospital’s delivery unit or birth centre. Some public hospitals provide for homebirth services as well.

In the public system, your pregnancy care is likely to be at:

• an antenatal clinic (at the hospital)
• a midwives’ clinic (at the hospital, birth centre or within the community)
• both your GP rooms and midwifery service as part of a shared care arrangement.

If your pregnancy becomes high risk or requires more intensive monitoring, you’ll also have the care of hospital doctors.

There are some pros and cons to being a public patient that you might want to consider. Advantages include:

• various care models of care to choose from within the hospital
• you can have care with little intervention but still have medical back-up if needed
• out-of-hours clinics are often available
• facilities for high-risk pregnancies and very sick babies are usually available in major public hospitals.

Disadvantages include:

• you’re more likely to share a room after you give birth
• appointment waiting times can stretch out compared to private practices
• you don’t always see the same doctor or midwife.

The best way to make an appropriate choice is to be informed, be prepared with an eligible health policy and be ready for an exciting journey ahead.