The federal government must address missing and inadequate rebates, and keep a firmer hand on the bundled model-loving private insurers.
The AMA has told the federal government to take urgent steps to bolster the private maternity care sector or risk patient safety and an imbalance between public and private services.
The warning came in the wake of news last week that the Northern Territory would be left with no private obstetric services at all, with the last private obstetrician closing her practice next month.
Underfunding, pressure from private health insurers and the inadequacy, and sometimes total absence, of relevant MBS and insurer rebates, were the big concerns for the AMA.
“The level of funding to support private maternity must support a viable and sustainable service, recognising the importance of maintaining a balanced system of private versus public delivery of services,” said the AMA’s position statement.
“MBS and private health insurance rebates for medical item numbers relevant to maternity care (including those for GPs, obstetricians, anaesthetists, gynaecologists, paediatricians, pathologists, physicians, and psychiatrists) must be corrected to remove gender bias.
“Correction of gender bias requires increasing rebates for some MBS items, such as the currently inadequate rebates for antenatal consultations and maternity-related diagnostic imaging.
“In other cases, it requires establishing MBS items and insurer rebates for services that are currently unfunded, such as paediatrician-specific MBS items for private neonate hospital attendances.
“The inadequacy — or complete absence — of such rebates is threatening the quality, safety, and viability of the private model of maternity care by reducing the viability of private specialist maternity-related practice and increasing out-of-pocket costs for patients.”
The AMA also wants to see MBS and insurer rebates for private specialist maternity care increased to close the funding gap caused by the Medicare indexation freeze between 2013 and 2019).
“Policy settings and government funding should provide appropriate incentives and support for patients to access private maternity services led by the doctor of their choice, recognising that maternity care has traditionally been seen as an important part of attracting consumers into and maintaining the value proposition of private health insurance.”
Health insurers needed to come under more government scrutiny, the association said.
“The Australian government must review private health insurance product tiers and risk equalisation settings to ensure there are private health insurance policy products that include cover for maternity services that are affordable and accessible when needed,” it said.
“Private health insurance contracts with clinicians for maternity care must not interfere with the clinical autonomy of doctors and other health practitioners involved in the patient’s care at any point in their pregnancy, or direct when and where the patient should receive treatment.
“Patient choice is the foundation of the private health system.
“Within accepted safety parameters, any patient whose private health insurance covers maternity care must be supported to choose the clinician they want to lead their maternity care and the setting/facility in which they want to give birth.”
The AMA said it rejected the concept of “bundled” models of private maternity funding, which are being pushed recently by insurance lobby groups such as Private Healthcare Australia.
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A bundled model requires a “lead clinician” – an obstetrician, GP, or midwife – to negotiate a single price in advance of any other practitioners who may need to be involved in the care of mother and newborn.
“Such models are impractical and administratively unworkable and would greatly increase the medico-legal risk of the ‘lead clinician’,” said the AMA.
“They may also increase risks to patient safety and reduce continuity of care, not least because the care the patient and newborn child may need cannot be accurately predicted early in the pregnancy, or because clinicians who agreed to the bundled price may be unavailable at the time of the birth.”
Insurance companies which introduced bundled models should be banned from coercing clinicians in private practice by refusing to pay them the medical benefits they would usually pay for the services clinicians provided in hospital.
The AMA also called for the establishment of a public national maternity clinical quality registry which included a consumer search function.
“[This would] ensure that accurate, up-to-date information on the quality and safety of different models of maternity care is available to both policymakers and the public,” it said.
Read the full position statement here.
