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Billion-dollar babies: Pressure on public health as private births decline · The Front

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  Speaker 1: From The Australian. Here's what's on the front. I'm Kristin Amiot.
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  Speaker 1: It's Tuesday, April fifteenth, twenty twenty five. A man who
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  Speaker 1: up to the federal election on May three, and it
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  Speaker 1: could come at the expense of our defense force. The
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  Speaker 1: pre poll cash splash is threatening to push a boost
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  Speaker 1: on defense spending into the next decade. Those exclusive stories
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  Speaker 1: alive right now at The Australian dot com dot au.
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  Speaker 1: Obstetricians offering to help women give birth in the private
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  Speaker 1: healthcare system are leaving the field altogether because public hospitals
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  Speaker 1: won't let them deliver babies at their facilities. It's part
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  Speaker 1: of a bigger problem plaguing birth in Australia, and experts
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  Speaker 1: say it's only going to get worse if big structural
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  Speaker 1: changes aren't made. That's today's episode. In twenty fourteen, Bendigo
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  Speaker 1: woman Karin Cintel made a mad rush to the hospital.
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  Speaker 1: Her baby girl, Matilda was coming and she wasn't gonna
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  Speaker 1: wait for Karin to arrive at Castlemaine Hospital. About forty
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  Speaker 1: minutes down the road, Karin's husband Mishi, pulled over near
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  Speaker 1: a fruit shop on the Midland Highway and she delivered
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  Speaker 1: Matilda right there in the passenger seat. It just so happened.
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  Speaker 1: The family's birth photographer, Brianna Gravener, was also on the road.
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  Speaker 1: Karin's birth photographer, Brianna had followed the couple from their
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  Speaker 1: house and captured the entire experience on camera. They suddenly
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  Speaker 1: pulled over and I thought, this is it. It was
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  Speaker 1: the first click and that was Matilda coming out. Amazing
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  Speaker 1: and unbelievable. Birth stories like this one are told around
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  Speaker 1: Australia and the world, but not all Australian babies are
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  Speaker 1: in as much of a rush as little Matilda. They're
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  Speaker 1: born in hospitals carefully selected by their mums and dads.
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  Speaker 1: In Australia, they have the choice between private hospitals which
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  Speaker 1: are funded by health insurance premiums and the public system,
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  Speaker 1: which is paid for by taxpayers. The private healthcare system
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  Speaker 1: was introduced to take the pressure off the publicly funded system,
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  Speaker 1: but when it comes to the business of delivering babies,
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  Speaker 1: the private system is in big trouble.
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  Speaker 2: There's been eighteen birth units that have closed in private
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  Speaker 2: hospitals in Australia over the past seven or so years.
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  Speaker 1: Natasha Robinson is the Australian's Health Editor.
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  Speaker 2: But this trend is accelerating, so about ten of them
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  Speaker 2: have been in the last three to four years, and
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  Speaker 2: the prospects, or the modeling of the prospects, are quite dire. Indeed,
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  Speaker 2: there has been modeling published recently in the Medical Journal
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  Speaker 2: of Australia that predicts a very precipitous decline of private
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  Speaker 2: births that will cause greater shutdowns of these units, to
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  Speaker 2: the extent where private birthing may be extinct. It is
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  Speaker 2: described in Australia by twenty thirty.
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  Speaker 1: So why are private birth units closing?
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  Speaker 2: Well, Australia has a declining birth rate. It's actually at
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  Speaker 2: an all time low. Our fertility rate is falling year
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  Speaker 2: upon year and it's affecting both systems. But the decline
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  Speaker 2: of the births in the private systems have more complex
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  Speaker 2: reasons them and they include factors to do with private
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  Speaker 2: health insurance, out of pocket costs to families, incredibly high
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  Speaker 2: costs to private hospitals to staff these units, and it
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  Speaker 2: really is becoming unviable for many hospitals. And the fact
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  Speaker 2: is that at the moment they are only really keeping
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  Speaker 2: them open because that is the service to the community.
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  Speaker 2: Many of these private birthing units are causing such a
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  Speaker 2: drain on the hospitals that they're being operated at a loss.
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  Speaker 1: The problem is when expectant mums can't access the private system,
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  Speaker 1: they turn to public hospitals and services to have their babies,
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  Speaker 1: and that could cost us all dearly in the long run.
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  Speaker 2: There's been some recent modeling done by a Monash University
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  Speaker 2: professor by the name of Emily Calendar, who is an
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  Speaker 2: economist and she specializes in women's and children's health. She's
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  Speaker 2: analyzed birthing trends in Australia and really use quite conservative figures. So,
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  Speaker 2: for instance, if we had a few two percent decline
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  Speaker 2: in bursts in the private system in Australia, which is
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  Speaker 2: really not out of the question in terms of where
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  Speaker 2: these numbers are going, then taxpayers would effectively subsidize the
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  Speaker 2: public system where women would have to go to give
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  Speaker 2: birth to the tune of a billion dollars annually. And
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  Speaker 2: she said if the entire system collapses, it'd be a
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  Speaker 2: one point five billion dollar cost to taxpayers because women
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  Speaker 2: would have no other choice. That is also amplified by
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  Speaker 2: the fact that her analysis shows that if you compare
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  Speaker 2: like for like women and labors and births, adjusted for
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  Speaker 2: all those factors like socioeconomic status, high risk pregnancies, and
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  Speaker 2: clinical factors to do with the health of the mother,
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  Speaker 2: then actually still cost tax payers more to subsidize a
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  Speaker 2: birth in a public hospital than it does in a
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  Speaker 2: private hospital. And that's for all sorts of reasons of efficiency,
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  Speaker 2: continuity of care obstrations, having to account for every cost
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  Speaker 2: whereas as hospitals don't, so the costs are really enormous.
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  Speaker 2: Here to put it in perspective, it's a fair chunk
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  Speaker 2: of the entire extra budget that the Commonwealth and states
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  Speaker 2: have tipped in two hospitals in the National Health Reform
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  Speaker 2: Agreement that has been signed recently, which is just an
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  Speaker 2: interim agreement. So it's a very large figure and more importantly,
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  Speaker 2: it's a tragedy if people were not to have a choice,
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  Speaker 2: because our health system is predicated on universality and choice.
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  Speaker 1: So how do you stop the bleed?
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  Speaker 2: Look, we have seen some plans devised recently, and this
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  Speaker 2: is supercharged by this sleeper issue that there is this
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  Speaker 2: emerging evidence also done by Emily Calendar and her colleague,
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  Speaker 2: professor Elaina tid At Monash, which shows a higher rate
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  Speaker 2: of adverse outcomes in the public system versus the private system.
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  Speaker 2: So the solutions that are on the table at the
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  Speaker 2: moment are things like devising national law so that each
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  Speaker 2: state adopted the same laws that would guarantee things like access,
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  Speaker 2: they would transparently track outcomes, and there's a number of
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  Speaker 2: aspects of things that could be regulated and legislated in
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  Speaker 2: a law like that, and that is modeled on many
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  Speaker 2: national laws that govern issues in all sorts of milias
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  Speaker 2: of society. Another one is some adjustments to private health insurance.
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  Speaker 2: So at the moment, people who have gold Cover are
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  Speaker 2: the only ones virtually that have that access through their
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  Speaker 2: private insurance to services for maternity, and a lot of
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  Speaker 2: the time people don't realize that they downgrade they cover
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  Speaker 2: that don't realize they're not covered for maternity. Another one
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  Speaker 2: is just to actually force all public hospitals to open
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  Speaker 2: up their systems so that private obstetricians can deliver babies
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  Speaker 2: in public hospitals. From their point of view, that's not
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  Speaker 2: ideal because it is actually not the same mode of care.
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  Speaker 2: They can't plan their cesarean sections easily, for instance, because
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  Speaker 2: they don't know if they're going to have access to theaters,
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  Speaker 2: et cetera, et cetera. So that is not ideal. But
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  Speaker 2: that's one of the solutions being proffered.
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  Speaker 1: Coming up, while some obstetricians are getting out of the
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  Speaker 1: game altogether.
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  Speaker 3: Having a baby can be a time of immense vulnerability
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  Speaker 3: and fear for many women.
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  Speaker 1: This is doctor Anusha Lasari, a specialist obstrarician and gynecologist
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  Speaker 1: based in Far North, Queensland, and knowing.
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  Speaker 3: That a single clinician is in charge of her kid
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  Speaker 3: and is fully accountable for her experience as well as
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  Speaker 3: her outcomes, allows women to bork without fear and with
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  Speaker 3: confidence because she knows this clinician will stand with her
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  Speaker 3: come what may.
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  Speaker 1: Doctor Lasari has spent a good chunk of her career
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  Speaker 1: in Australia, providing medical care to women living in remote
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  Speaker 1: and regional communities up north.
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  Speaker 3: Continuity of care also makes the patient journey safer. One
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  Speaker 3: set of eyes on one patient, not just in their
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  Speaker 3: first pregnancy, but every subsequent pregnancy allows that clinician to
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  Speaker 3: recognize evolving risks early and perform timely small intervention measures
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  Speaker 3: that prevent major address outcomets.
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  Speaker 1: But as private birth units are shuttered around the country,
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  Speaker 1: this type of continuous care is becoming a rarity. Adding
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  Speaker 1: to the problem is the fact that some obstratacians are
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  Speaker 1: leaving the field. Here's Natasha Robinson.
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  Speaker 2: You do have a situation in cans where the entire
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  Speaker 2: a cohort of private obsetricians, and that a couple of
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  Speaker 2: years ago there were seven of them are now not
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  Speaker 2: working in obstetrics and not delivering babies at all. A
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  Speaker 2: couple of them have left town. The ones that are
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  Speaker 2: left mostly doing only gynecological services. And I don't think
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  Speaker 2: it's putting it dramatically to say that they're grief stricken.
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  Speaker 2: They are devastated, and patients are also devastated because they
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  Speaker 2: have to travel to give birth with a private obstetrician.
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  Speaker 2: We have an entire capital city of Darwin, where the
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  Speaker 2: private birthing unit at the Healthscope Hospital is about to
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  Speaker 2: shut down in three days and women there across the
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  Speaker 2: hole of the top end have no option but to
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  Speaker 2: birth in the public hospital. Now it's better there because
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  Speaker 2: they do still have their private obstrition. Their private obstricans
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  Speaker 2: have been granted access to birth in the public system
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  Speaker 2: in terms of cans. That did happen initially, but that
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  Speaker 2: right has been removed by the local hospital disc and
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  Speaker 2: it's unclear as to why that has happened. The solution
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  Speaker 2: that makes the most sense to me in my discussions
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  Speaker 2: with doctors is that the Medicare funding for the actual
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  Speaker 2: delivery of the baby, if it's done in the public hospital,
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  Speaker 2: flows to the hospital if that birth is done a
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  Speaker 2: public obstrician, But if it's a private obstrician coming in
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  Speaker 2: delivering that baby, that Medicare rebate goes via the patient
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  Speaker 2: to the obstrician themselves. So I don't know what the
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  Speaker 2: reason is, but it's certainly surprising, and it's something that
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  Speaker 2: a great deal of pressure is now building for a
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  Speaker 2: change that which we really could be done at the
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  Speaker 2: stroke of a pen.
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  Speaker 1: So what does this all mean for mums and bubs.
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  Speaker 2: What it means is that they don't have a choice.
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  Speaker 2: In some places in Australia, this is an escalating situation
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  Speaker 2: and it's not to mention even the rural areas where
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  Speaker 2: this has been happening for years and women are traveling
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  Speaker 2: enormous distances, they're relying on private midwives. It really is
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  Speaker 2: quite extraordinary. And the situation for women is they're facing
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  Speaker 2: perhaps a different standard of care because the most important
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  Speaker 2: thing that everybody agrees upon in antinatal care and labor
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  Speaker 2: and delivery is that there is continuity of care. I
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  Speaker 2: think that is the message that non continuity of care
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  Speaker 2: models involving multi professionals in public systems where there's this
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  Speaker 2: sort of divide between oftentimes midwives and obstetricians, is not working.
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  Speaker 2: And there is an alternative, excellent model in the public
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  Speaker 2: system which is midwiffree group care, and that has very
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  Speaker 2: good outcomes. If we cannot solve these big problems in
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  Speaker 2: terms of the viability of private hospitals and the birthing units,
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  Speaker 2: in terms of the fertility trends that really are such
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  Speaker 2: a huge problem to solve, the problem we can solve
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  Speaker 2: is actually adjusting our models so that they can be
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  Speaker 2: of the highest standard of best practice. And I really
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  Speaker 2: think that's probably the gold mine here where you're going
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  Speaker 2: to find a lot of progress. And the critical other
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  Speaker 2: point to keep in mind is that our progress on
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  Speaker 2: these matters must be transparent. So that is the big push.
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  Speaker 2: It has to be that women are told that they
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  Speaker 2: can look up information that is not just all about
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  Speaker 2: the mode of delivery, that is not just all about
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  Speaker 2: was there an intervention or not, but is about the outcome.
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  Speaker 2: They are the figures that we need. They're the figures
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  Speaker 2: that we currently don't have. They're not available at all.
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  Speaker 2: It's incredibly difficult for researchers to get access to them,
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  Speaker 2: let alone birthing women. So that's an incredibly important reform
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  Speaker 2: as well that we need to move towards.
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  Speaker 1: Natasha Robinson is The Australian's Health Editor. You can read
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  Speaker 1: all her reporting and analysis of the crisis engulfing the
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  Speaker 1: nation's maternity wards anytime at the Australian dot com dot
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  Speaker 1: au