Canberra obstetrician Dr Andrew Foote is in today’s Canberra Times saying that “public hospital is safe, but private hospital is safer”. He is concerned that since government capped the Medicare Safety Net payments for obstetric services, women with private health insurance are choosing to have their babies in public hospitals because of the gap fees. He wants Medicare rebates lifted to cover the $2,000 average out of pocket costs.
For anyone wanting to know where is the safest place to give birth, it is worth having a look at ACT Health’s maternal and perinatal health statistics. For example, in 2008 the caesarean rate in Calvary Private was 32.6% and 43.6% at John James. In Canberra Hodpital public it was 23.9% (this includes the Birth Centre and high-risk Fetal Medicine Unit) and 26% at Calvary Public. Induction rates and caesareans with no prior onset of labour were highest in 2008 at Calvary and John James.
The rate of serious tearing (3rd or 4th degree) is higher in public hospitals – 3% at TCH compared to 1.2% at Calvary Private and 0.9% at John James. But the rate of intact perineums – no stitches at all – is 38% at TCH compared to 23% at Calvary and 23.7% at John James. There’s no breakdown of babies stay in special care by hospital, but TCH having the only NICU means they will have the babies who need the most acute care.
What Dr Foote hasn’t talked about in the Canberra Times article are the other factors that affect decisions about where to have babies. Both Calvary and John James hospitals are now run by Little Company of Mary. For women who prefer not to be in a Catholic hospital, which does affect the range of procedures and the information care providers are able to give women, TCH is the only alternative. Some women might prefer the model of care offered at the Birth Centre within TCH, which is quite different to the hospital maternity units. Equally, some women may be choosing Calvary Private or John James for the private rooms in recovery, which can only be accessed if you have a private doctor. Or they may prefer to see a doctor who works primarily at one particular hospital. Choosing a maternity hospital is far more complex than just the cost.
There are some statistics that are not available in the ACT Health publications, and the most recent data is from 2008. And of course, personal health history and philosophy (eg what risks and outcomes you can best cope with) are more important than stats in deciding what is best for an individual situation. No birth is risk-free, and it is good to be informed about how different outcomes can come about when choosing your model of care.
Women who medically require a surgeon are referred to a public obstetrician at TCH if they cannot afford private care. Increasing the Medicare Safety Net for obstetric services will almost certainly increase the costs to taxpayers for payments to private obstetricians. Around half of the total Medicare Safety Net budget was paid for obstetric services before the limitation was put in place. It will not necessarily improve the health of mothers and babies.
A better plan, in my opinion, would be to provide ACT healthcare consumers – women – with more detailed and up to date information about maternal and perinatal health outcomes, and all their options for maternity care. Perhaps as a booklet available from GPs and pharmacies, so women can get this information when they first find out they’re pregnant. The birth care that suits one woman might be unacceptable to another, so it is good to have multiple models of care offered in our community.
Dr Foote’s own research shows that women will choose what they believe is best for their baby and their own health, so why not just give the women the information and then respect their right to choose?