海角破解版

Private O&G Services Under Threat in Australia Due to Systemic Gender Bias

海角破解版 leads call for urgent reform in private obstetrics and gynaecology sector.

海角破解版

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

Updated
14 November 2024
SHARE

Australia’s private obstetrics and gynaecology services are facing a significant threat, with systemic gender bias in funding and insurance contributing to an unfolding crisis that will profoundly limit options for women and further strain the nation鈥檚 public healthcare system.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (海角破解版; the College) convened a roundtable on 14 November bringing together service providers, policymakers, insurers, and other market participants from the private sector to discuss urgent collective reform needed to protect services.


Private maternity services are becoming financial unsustainable. Between 2015鈥16 and 2022鈥23, 9 private hospitals closed their maternity wards, and 2 hospitals with maternity services ceased operating. 1 In the meantime, at least an additional 4 private maternity services have closed, or are scheduled to close. [See Table 1]

The Department of Health and Aged Care鈥檚 recent Financial Health Check of the Private Hospital Sector, highlights obstetrics and mental health as areas 鈥渙f particular concern,鈥 underscoring the need for immediate action.

There are also increasing barriers to provision of some gynaecological procedures in the private setting. The remuneration private hospitals receive from insurers does not offset the hospital鈥檚 expenses for providing these services, therefore practitioners are sometimes advised not to offer them.

Health funds frequently underpay private hospitals for obstetric and gynaecological services, failing to acknowledge the actual costs. As a result, when evaluating financial viability, private hospitals tend to favour more profitable specialist services over those focused on women鈥檚 health.

Maternity care is especially costly for private hospitals to provide due to the unpredictability of labour, which leads to highly variable demand. Hospitals must have staff available 24/7 鈥 including services such as neonatology, paediatrics, and anaesthetics 鈥 but insurers don鈥檛 account for these fluctuations, underpaying hospitals and rendering such services financially unsustainable.

Financial challenges are exacerbated by declining demand. Private hospital births declined by 4.7% from 2018/19 to 2022/23.2 Fewer women are opting for private maternity care due to rising premiums and out-of-pocket costs indicative of gender bias in health insurance. Women with private insurance face disproportionate expenses for childbirth. Full coverage for pregnancy and birth is only available through the most expensive “gold cover” policies, which also require a 12-month waiting period for obstetric claims.

For aspiring parents, the costs for 鈥済old cover鈥 policies are substantial, totalling approximately $6,557.25 per year during the 12-month waiting period. For those who become pregnant after the waiting period, an additional $4,917.93 is required for a further nine months of coverage. This brings the total to a staggering $11,475.183, a figure that is simply unaffordable for many families in the current cost-of-living crisis.

As a result, many women who hold private health insurance drop obstetrics and gynaecology cover to make their premiums cheaper opting to receive care through public providers, adding strain to the underfunded and overburdened public system and simultaneously reducing demand for private maternity services in a perpetuating cycle.

Growing out-of-pocket costs for obstetrics and gynaecology (O&G) patients highlight the gap between actual fees and Medicare rebates, which have not been updated in decades and fail to cover the true cost of care. As a result, specialists often charge gap fees to make up for what Medicare Benefits Schedule (MBS) items do not cover.

Additionally, the MBS tends to provide higher remuneration for non-O&G procedures; for instance, anaesthetists receive more favourable payments, including higher remuneration for overnight procedures. In contrast, obstetrics and gynaecology services are underfunded, leaving patients to bear a larger share of the costs.

Gender-bias within the MBS also plays a part. The Extended Medicare Safety Net (EMSN), which covers up to 80% of additional out-of-pocket costs once an annual threshold is met has caps on obstetric care and IVF. Other specialties, like psychiatry, are unaffected by similar restrictions. This exclusively disadvantages women.

A thorough review of obstetric and gynaecological MBS item numbers must be undertaken to remove current gender biases within the system.

Australia鈥檚 healthcare system, ranked among the best globally, relies on a robust private sector to support the public system. Currently, one in four births takes place in private hospitals4, and 70% of elective women鈥檚 health procedures occur in private settings.5 The financial disincentives and structural biases that undermine private obstetric and gynaecological services disrupt this balance, putting further strain on public facilities that were not designed to manage such a demand. We must make private healthcare sustainable to maintain Australia鈥檚 health ecosystem.

The decline of private obstetrics and gynaecology services deprives women of choice and jeopardises access to timely, specialised care. Women facing high-risk pregnancies or those who prioritise continuity of care with an obstetrician, as well as those requiring gynaecological procedures sooner than the public system can accommodate often rely on private services.

In Australia, the average wait time for public gynaecology procedures is 454 days (1.25 years)6. Without private options, the strain on the public system increases, leading to even longer wait times and worsening health conditions for many women.

The closure of private facilities also exacerbates growing 鈥渕aternity deserts鈥 in rural, regional, and remote areas, forcing some women to travel hours for essential care. Those with private health insurance in these areas find it increasingly difficult to use their coverage. Moreover, as private obstetrics services close, multidisciplinary practicing specialists often leave these communities, further reducing access to care.

The neglect of private women鈥檚 health services reflects the systemic gender bias embedded in Australia鈥檚 healthcare and policy frameworks. Addressing this issue is urgent; we must prioritise private practice reform to preserve their choices and ensure equitable, accessible care for all women.

海角破解版 held a Private Practice Roundtable at Djeembana (1 Bowen Crescent) in Melbourne on 14 November which convened key stakeholders from the College, the government, the private insurance sector and other鈥痮rganisations鈥痺ith an interest in private O&G.

The aim of the roundtable was to understand the current private practice landscape, challenges and opportunities across Australian states and territories, work with private health insurers to make maternity care more affordable and accessible and aim to improve gender equity and women鈥檚 choices.

The event attracted high-profile attendees including the Hon. Ged Kearney, Assistant Minister for Health and Aged Care, representation from the office of Shadow Minister for Health and Aged Care, Anne Ruston (pre-recorded by Anne), First Assistant Secretary, Health Workforce, Eliza Strapp, and Member of Parliament for the Federal Seat of Kooyong, Dr Monique Ryan.


Private Maternity Service Closures Outside of Reporting of the Financial Health Check of the Private Hospital SectorState/TerritoryClosure date
Gosford Private HospitalNew South WalesMar-25
Healthscope Sydney Southwest Private HospitalNew South WalesDec-24
St John of God Bunbury HospitalWestern AustraliaJun-24
Mater Private Hospital RedlandQueenslandMay-24

1 Australian Department of Health and Aged Care (2024), Accessed 13 Nov. 2024, Private Hospital Sector Financial Health Check 鈥 Summary,

2 Australian Department of Health and Aged Care (2024), Accessed 13 Nov. 2024, Private Hospital Sector Financial Health Check 鈥 Summary,

3 Privatehealth.gov.au, 2024, Accessed 11 Nov. 2024, Compare Policies,

4 Australian Institute of Health and Welfare (AIHW) 2024, Accessed 13 Nov 2024, Australia鈥檚 mothers and babies,

5 Australian Institute of Health and Welfare (AIHW) 2024, Accessed 13 Nov 2024, Australia鈥檚 Hospitals at a Glance,

6 Safewise, 2024, www.safewise.com, Accessed 12 Nov. 2024,
[]


For media enquiries

Bec McPhee
Head of Advocacy & Communications
bmcphee@ranzcog.edu.au
+61 413 258 166

CATEGORIES
Advocacy Women’s health

LATEST NEWS

Our Members 22 November 2024
海角破解版 Extraordinary General Meeting
Extraordinary General Meeting (EGM) of Fellows of the 海角破解版 will…
Advocacy 18 November 2024
海角破解版 reaffirms commitment to Te Tiriti o Waitangi and health equity
海角破解版 is committed to continuing the journey towards equity and…
Training 1 November 2024
海角破解版鈥檚 Fetal Surveillance Education Program Achieves Record Numbers
The 海角破解版 Fetal Surveillance Education Program has achieved over 36,000…
Advocacy 21 October 2024
Health and Safety Must Take Precedence Over Political Agendas: Defend Abortion Rights in Queensland
海角破解版 and leading health and advocacy organisations have come together…
the College 16 October 2024
海角破解版 Echoes Calls for Pause on Expedited SIMG Pathways to Address Complex Workforce Challenges聽
海角破解版 urges a pause on the expedited SIMG pathways, citing…
Advocacy 20 September 2024
Committee Supports Women’s Rights by Choosing Not to Recommend Abortion Bill
An unnecessary and dangerous abortion bill in Queensland will expire…
Advocacy 19 September 2024
Menopause Report a Solid Foundation for Improving Care
海角破解版 supports recommendations outlined in the Senate Committee’s report on…
the College 19 September 2024
2024 海角破解版 Honours and Awards Winners
Congratulations to the 2024 海角破解版 Honours and Awards Winners…