03 Aug 2010

Goodbye, medicare safety net

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News reports out today (including on the front page of the Sydney Morning Herald) seem to confirm what many of us have expected for some time – that obstetric services will be removed from the Medicare Safety net in next tueday’s budget.

It would have been political suicide for the Federal Government to renege on their election promise to maintain the safety net and there is growing resistance out there to the current trend of means testing pretty much everything.

Currently most obstetricians – including myself – charge what would normally be a “Gap” fee as the “Planning and Managment” fee that attracts Medicare rebates under the Safety Net. Unfortunately it is true that some practitioners have charged fees of up to $10,000 under this system so it is not surprising the Government is concerned.

On the other hand it is worth pointing out that the current system is not what obstetricians wanted. Our professional bodies simply sought reasonable scheduled fees (ie the amounts Medicare and Health Funds pay to patients) that reflected the costs of providing pregnancy care. Currently the scheduled fee for an entire pregnancy, birth, and postnatal period amounts to less than $1,000 ($1,500 if the pregnancy is very complicated). That amount does not cover my costs (rent, equipment and – most importantly – indemnity insurance).

Perhaps patients need to ask themselves – and the Government, who sets the official schedule of fees – whether taxpayers who also shell out for Health Insurance deserve to have to find out of pocket expenses of a number of thousand dollars for their maternity care.

Of course for many this will mean private obstetric care – even for the insured – will be unaffordable and many will need to be cared for in the public system. While this shift will align with a number of Government policy objectives, there are two problems:

1. The public maternity system is under considerable presssure because of the high number of women giving birth these days (although of course many will be reconsidering having children now), and

2. As I pointed out in my blog earlier this week the private maternity system is safer than the public system.

Until recently I charged somewhere between $5,000 and $7,000 for care during an entire pregnancy, birth and postnatal period. The exact amount depends upon the complexity of the pregnancy and I have recently reduced my fees because of the Global Financial Crisis. I believe that these amounts are not unreasonable given the responsibility and skill required along with the fact that my patients have a specialist on the end of a cell phone 24/7. Many will disagree with me but I suggest they try retaining a lawyer, accountant or even a tradesman under a similar arrangement for nine months and see what it costs.

That said I will do all I can to minimise the out of pocket expenses my patients pay.

I urge you not to panic about the changes that are upon us and to not rule out private obstetric care just yet. Come and see me – or your favourite obstetrician if it is not me – and discuss fees in the new era.

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