WEALTHY expectant mothers are being charged as much as $20,000 to give birth in private hospitals.
An investigation by The Daily Telegraph reveals NSW is home to some of the most expensive obstetricians in the country, with some women paying more simply because of where they live.
The revelation comes as the state's chief obstetrician Dr Alec Welsh revealed many of his colleagues appear to have jacked-up up their fees in order to milk the taxpayer-funded system.
Dr Keith Hartman - considered the obstetrician to the stars - charges $9345 for his services.
That makes Dr Hartman ... one of the most expensive obstetricians in the country.
And if an expectant mother chooses to have Dr Hartman and give birth at Sydney's top private hospital, Mater Hospital at Crows Nest, she could be hit with a bill of more than $20,000.
Mater Hospital is the birth place to many wealthy celebrity bubs, including Indigo Packer and Cate Blanchett's three sons.
... where you live can determine how much you are charged for a private obstetrician.
In Penrith, Dr John Pardy charges more than $3000 while in regional areas such as Orange the average fee is about $1200 to $1400.
The Federal Government has just ordered a crackdown on skyrocketing fees by changing the amount women can claim back through the safety net.
It hopes by doing this doctors will either lower their fees or women will chose a cheaper option.
Private midwifery provides this option. Fees range between $4000 and $5000 in Sydney, and private midwives do not charge more simply because women live in a wealthy suburb. Whereever you live, you are assured the same high quality care and service, all in your home, at a time that suits you. Private health insurance benefits may apply, and services qualify for the net medical expenses tax off-set. Private midwifery is available for home or hospital birth.
But Australian Medical Association's newly elected president Dr Andrew Pesce, who is also an obstetrician, believes the Government's reforms don't go far enough.
"I believe the Government didn't estimate for the majority of women who are seeing private obstetrician who will be worse off under the funding arrangement," he said.
"Some women will not meet the threshold of $1100 and they won't get a single cent back."
So this, in effect, provides women with a financial dis-incentive to have private obstetric care. is this such a bad thing, if healthy pregnant women are forced to consider other options that are actually safer for them, such as midwifery care? Maybe it will go a long way in reducing the country's disgraceful record of medical intervention, most of which is unjustified.
Obstetrician fees increased by 16.2 per cent between 2006 and 2007 - from $1088.55 to $1264. By July 2008, the average fee was $1980.
The dramatic increase in costs means that Medicare is now paying three times as much in fees per private birth as it was a decade ago. It was $721 per birth in 1997-98 compared with $2357 per birth in 2007-08.
Women's advocacy group What Women Want organiser Justine Caines said unless the birth was considered high risk, there wasn't much difference in the services offered.
I love Justine, but I disagree with this comment. Private midwifery care means all care in your home. Consultations are 1 to 2 hours long. And the midwife isn't just called for the birth - maybe making it, maybe not. The midwife is there throughout the labour, birth and early postnatal period. It's true continuity of care. I calculated that the average private midwifery service may include 86 hours of care. Name an obstetrician who provides this level of care.
"Sometimes you don't even get your obstetrician that you paid thousands for at your birth because he/she isn't working that late at night or weekend," Ms Caines said.
"All women should have choices and we are not criticising if a woman decides she wants an obstetrician.
... While obstetricians are cagey about their fees, one leading specialist has spoken out about the exorbitant costs.
NSW chair of the Royal Australian and New Zealand College of Obstetrician and Gynaecologists Alec Welsh said he wondered whether obstetricians would "fix their fees at the same level" if they knew the Medicare Safety Net was covering the majority.
"If a private practitioner feels their skills are worth a certain amount, that's fine but I don't think that should necessarily come from a national purse and that's particularly at a time when the hospitals are struggling," he said.
Professor Welsh, a strong advocate of the public system, is also head of a program at RHW in which midwives are in control of low and medium risk births - a necessity caused by a shortage of obstetrician in the public sector.
And no doubt demand for services that are woman-friendly, that give women a sense of control, and that allow women to have a known midwife with them the whole way through their pregnancy, birth and postnatal period.
"It's very hard for us to fill public hospital specialist positions, even with some of the major teaching hospitals in Sydney, because from the perspective of personal remuneration the alternative is so attractive," he said.