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Fewer women giving birth in the private hospital system due to rising gap fees is now an “existential threat” to private obstetrics that risks overloading public hospitals, specialists say.

Only 10 per cent of privately insured mothers didn’t have to pay a gap fee when they gave birth last year, federal health department data shows. The average gap was $800 for a caesarean and $700 for a vaginal delivery. This cost, which only covers the birth, varies by the complexity of birth, state, lipitor prices online hospital and specialist.

Lou Rytmeister, who didn’t use her private health insurance when her third child, Ruby, was born at Gosford Hospital.Credit:Steven Siewert

The proportion of women electing to have a baby using their private health insurance has fallen from 33 per cent in 2010 to 29 per cent in 2018, the Australian Institute of Health and Welfare found.

High numbers of caesarean births are adding to the cost of insurance with about 45 per cent of all births in private hospitals by c-section, compared with 30 per cent in the public system. The World Health Organisation recommends a rate of 10-15 per cent. Private health insurers also say gap fees for obstetrics are high because legislation prohibits covering some costs.

National Association of Specialist Obstetricians and Gynaecologists president Associate Professor Gino Pecoraro said poor rebates from both Medicare and private health insurers mean mothers are paying more for births or going to the public system.

“What we’re facing is an existential threat to private obstetrics, it’s that serious,” Dr Pecoraro said. “The insurance policy rebates don’t cover the cost of providing the service.”

Karen Robertson said it was a wonderful experience giving birth two months ago to her daughter Daisy in Westmead Private Hospital but she is feeling “lucky” that her out-of-pocket costs for the entire birthing journey were about $2000.

“It’s so complicated. Honestly, I think we were just lucky,” Ms Robertson, 41, said. “We used to live in the inner west and I think if we were to have had our baby in a private hospital closer to the city the fees would definitely be a lot higher.”

Dr Pecoraro said that, because public hospitals were “chronically underfunded”, they charged private patients for services that are free for public patients.

“If you’re a private patient in a public hospital, you don’t get anything special, you get exactly the same pathology lab doing the tests, the same people doing the scans, [but] they’re charging you for each service while the person next to the private patient gets the scan done for free,” Dr Pecoraro said.

“As a specialist obstetrician, I offer treatment to people who need it. While there are more caesareans in the private sector, it also means fewer women traumatised with birth trauma; it’s up to the woman to decide.”

Lou Rytmeister had her third child, Ruby, at Gosford Hospital and didn’t use her private health insurance because “everything was covered as it was”, but she was diverted into the private system for scans for her first child.

“They would say the waiting list is too long to squeeze you in [for a scan] and it was only if it was urgent,” Ms Rytmeister said.

Monash University health economist Associate Professor Emily Callander studied the costs of childbirth, finding that, over the past 20 years, out‐of‐pocket charges rose by 1035 per cent for out‐of‐hospital items such as consultations with specialists and 77 per cent for in‐hospital services such as scans.

A rapid increase in interventions such as induction, epidural use and c-sections had also driven costs higher, Dr Callander said.

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