‘Baby bonus’ questioned
Mums’ group says complex birth rates don’t add up
HALF the babies delivered privately are being billed as complex births, a rate that has left consumer health groups astounded and questioning if doctors are price gouging.
Medicare data shows that of the 72,852 private births billed to Medicare in the 12 months between July 2017 and June 2018, 35,350 or 48% were billed as complex deliveries.
Doctors who claim a complex birth can bill patients almost $1000 more than when they attend a normal birth.
It comes as mothers’ groups push for the government to introduce a bundled payment system to remove the bill shock that can leave parents more than $10,000 out of pocket for a private birth.
Medicare pays a higher fee for complex births either natural or by caesarean section if the baby is breech, underweight or the mother had high blood pressure, diabetes or other health problems.
The Maternity Consumer Network director Alecia Staines says the high rate of billing for “complex” pregnancies in the private sector is “insane”.
“There is no way half of us are high risk,” she said.
The Medicare payment for a normal delivery is $693 compared to $1629 for a complicated one and she wonders whether that is what is really behind the billing practice.
A recent report by the federal government’s Independent Hospital Pricing Authority report found even in public hospitals there may be too much medical intervention in the birth process.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists spokesman Dr Will Milford said a recent government review of Medicare benefits resulted in the tightening of the criteria that applied before doctors could claim a complicated delivery from November.
However, a review of Medicare data shows, if anything, billing for complicated deliveries actually increased after those changes. Between November 2016 and June 2017 46.7% of privately births were billed as complicated compared to 48.9% between November 2017 and June 2018.
Ms Staines said it was time for the federal government to introduce a bundled payment system for maternity care similar to that in New Zealand, the UK and Canada.
Bundled pricing would see Medicare pay a single price for a full package of maternity care during the whole pregnancy from 10 weeks gestation to six weeks after the birth.
Such a scheme has been operating in New Zealand for around 20 years where there is a lower rate of growth in caesareans, forceps deliveries, inductions and epidurals and higher levels of patient satisfaction linked to the midwifeled contracting model.
The Government’s Independent Hospital Pricing Authority investigated such a payment system and recommended it last year, however, the inability to track an individual patient across multiple parts of the system means it has not been adopted.