The National Association of Specialist Obstetricians and Gynaecologists (NASOG) has serious concerns about Private Healthcare Australia’s (PHA) proposed bundled maternity payment model.
NASOG strongly supports maternity funding reforms and the reduction of out-of-pocket costs for private maternity patients, but we believe that this proposal places unrealistic financial, legal and administrative burdens on practitioners, while failing to ensure high-quality care for women and their babies.
“Any implementation of this kind of proposal will make it harder, not easier, for women to access safe, high-quality private maternity care,” said NASOG President A/Prof Gino Pecoraro.
“It is an unfair and unworkable model that would discourage doctors from offering maternity care and ultimately reduce choice for pregnant women.”
A/Prof Pecoraro observed that, “In putting this proposal forward, Dr David seems to lack understanding of how obstetrics service delivery works, as bundled payments will not solve the issues of choice and affordability.”
NASOG notes that the proposed structure would increase medico-legal risks for the lead practitioners by placing full responsibility on them (be it obstetrician, midwife, or GP), exposing them to vicarious liability for all services within the bundle. This makes it highly unappealing for practitioners.
“We cannot expect doctors to take on the financial and legal risk of an entire maternity team. The stakes are simply too high,” A/Prof Pecoraro said.
“If something goes wrong, who is ultimately responsible? This is just one question the proposal fails to answer.”
In a bundled payment arrangement, lead practitioners would need to manage contracts, payments, rostering and risk assessment for all providers in the bundle. To manage this, new administration systems would be needed, adding to practice costs and ultimately be passed onto patients.
A/Prof Pecoraro observed that, “Doctors train for over a decade to deliver babies—not to become financial administrators of bundled services,”
“This model puts more red tape between doctors and patients, which is the last thing our maternity system needs.”
NASOG insists that patients should not be forced to choose between affordability and safety. This type of bundled model could reduce access to private obstetricians, particularly for higher-risk pregnancies.
Maternity care is unpredictable, bundled payment arrangements may seem reasonable for a low-risk pregnancies, but any birth can suddenly become high-risk. This model lacks any indication of protocols for handling risk escalation and it is unknown whether a patient under a GP or midwife-led bundle would lose their financial benefits if an obstetrician is needed during their care.
In reforming funding for maternity services, Australia’s policymakers need to consult directly with the doctors and other healthcare professionals who provide expert maternity services.
They must not be swayed by proposals from corporate entities seeking to maximise shareholder profits and potentially increase risks for practitioners and patients.
“We need solutions that work for women and for the doctors who care for them,” A/Prof Pecoraro stated.
“Private maternity care is already at risk. We cannot afford to introduce a flawed funding model that drives more doctors away.”
“Surely if health funds genuinely wanted to make private hospital maternity care more affordable, pregnancy would be included in every health insurance policy.”
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