Private health insurance and caesarean rates

A recent study has demonstrated an association between private health insurance and caesarean rates. The Australian Private Health Insurance Incentive policy reforms that were implemented in 1997–2000 resulted in increased PHI membership in Australia.  When a woman finds out she is pregnant, her usual first port of call is her GP, and upon learning that she has private health insurance, GPs refer women to private obstetricians.  With more women privately insured, this has resulted in more referrals to private obstetricians for pregnancy and birth care.

There is concern that the the higher rate of obstetric interventions, particularly caesareans, are a direct result of more women seeing private obstetricians for their care.  As well as the increase in caesarean rates, thr length of stay in hospital after birth also increased; this would be due to the longer stay needed following major surgery.  The study concludes that, “The reforms may not have been beneficial for quality obstetric care in Australia or the burden of Australian hospitals”.

The study also showed that private patients were experiencing more interventions other than caesarean, such as episiotomy, forceps, vacuums, epidurals and inductions.  This was in comparison to women who booked into a public hospital to be treated as a public patient.

Although caesareans can be life-saving at times, high rates of intervention that is not warranted results in poorer outcomes for mothers and babies.  For mothers, this impacts not only the current birth, but also the pregnancies and births that follow.

The study found that, “In Australia, caesarean section rates rose from 18% in 1991 to 31% in 2008, reaching the same prevalence as in the United States in 2006”.  We like to think that the US has caesarean rates that are sky-high, however the reailty is that Australia’s caesarean rate is equal to that in the US.

Does this mean you should give up your private health insurance?  I would argue no because there are increasing options for women to use their private health insurance for pregnancy, birth and postnatal care.

In some States, women are able to be admitted to hosapital privately under the care of their midwife.  This will result in fewer interventions for women during birth, as recent research has demonstrated that women cared for by a midwife are far less likely to experience caesareans and other interventions when they are cared for by midwives.  Private health insurance is also helpful for the benefits it provides towards childbirth education and homebirth.  This is generally accessed through extras cover.

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