For women fortunate enough to be in a position to choose between giving birth in a public hospital or private hospital, the decision can be a difficult one. For some, it may come down to their location, or complex care needs. For others, though, it’s increasingly becoming a matter of finances.

Despite paying hefty premiums, many Australian mothers who chose to lean on their private health insurance for perinatal care still end up facing substantial bills. Often totalling thousands of dollars.

Brisbane teacher, Amy Pavez, was among them. The birth of her first child 18 months ago saw her face out-of-pocket costs of roughly $4,500.

LISTEN: Holly Wainwright and Andrew Daddo dive deep on what it’s really going to cost you to have a baby, from hospital costs to sparkly strollers.

Speaking to Mamamia, Amy said her decision to go with the private system wasn’t one taken lightly.

“Due to our financial situation at the time — me as a stay-at-home mum, and my husband as a part-time worker and student — we were considering going public,” she said.

“[But we] chose private for a few reasons. One, I didn’t want to feel forced out of hospital [after birth] if I went public, which is something I had heard from doctors… Also, my G.P. suggested that, based on how I’d spoken with her over the year, she thought I’d prefer more specific care where I could get to know one doctor.

“And we had insurance. So we decided that the benefit was worth the cost.”

The cost of giving birth: private hospitals vs public hospitals.

Emily Callander, Associate Professor of Health Economics at Griffith University, recently conducted research that shows just how much more private hospital patients, like Amy, ending up forking out for childbirth, from conception right through to 12 months postpartum.

“There’s huge variation [in out-of-pocket fees], but the average is $3,000,” she told Mamamia. “Compare that to women in the public system who paid around $500 on average.”

According to Assoc. Prof. Callander’s soon-to-be-published research, fees are significantly higher for private patients at every stage of natal care. At pregnancy, for example, they were 500 per cent higher. At the time of birth, 1200 per cent.

But even among private patients, out-of-pocket costs can vary hugely. That largely comes down to fact that private providers are free to set their own fees.

“There’s no regulation as to the amount that private providers can charge, because it’s a private business,” Assoc. Prof. Callander said. “By definition, they’re seeking to make a profit, so fees are generally charged at an amount that they believe women are willing or able to pay.”

Childbirth in a private hospital: avg. $3,000.

Private health insurers do not cover medical services that are provided out-of-hospital.

So, as consumer advocate CHOICE explains, “each time you visit your obstetrician, you may have out-of-pocket costs. The amount depends on if and how much they charge above the Medicare Scheduled Fee.”

This can add up, thanks to charges like a ‘planning and management fee’, a lump sum which can be several thousand dollars.

According to Assoc. Prof. Callander’s paper, the largest source of out-of-pocket fees for mothers who gave birth in private hospitals was obstetric services ($1,296).

And those fees have increased dramatically overtime. A previous James Cook University study, co-authored by Assoc. Prof. Callander, found that typical charges for single out-of-hospital obstetric services increased by 1,035 per cent between 1992/3 and 2016/17 — that’s far more than any other kind of health care.

Fortunately, Amy Pavez had done careful research about the providers at her local private hospital, and the clinic she chose had given her a clear breakdown of fees from the outset.

“I knew the basic cost would include 10-14 appointments, two scans at a different clinic, and the Pregnancy Management Fee — $2,900 before Medicare,” she said. “I researched a lot so that wasn’t a surprise, but it’s still a big cost.”

Still, she says the care she received was worth it. So much so that she's opting for the private system again with her next child, with whom she's currently pregnant.

"We were given exceptional care," she said. "I feel like we were treated as people, we were not made to feel insignificant, or inferior. No problem discussed was too stupid, nor was information ‘dumbed down’. It has been, and continues to be, a great experience."

Key point: Private health insurers and funds have a one-year waiting period for obstetric services.

Childbirth in a public hospital: avg. $500.

Women who give birth in public hospitals can walk away without having to pay a cent, as their bill is covered by Medicare. That includes appointments with hospital obstetricians and midwifes during pregnancy.

However, some services provided outside of the hospital may incur an out-of-pocket fee. For example, scans or blood tests, appointments with a G.P. who doesn't bulk bill, and childbirth classes.

Sydney mum, Jennifer Case, gave birth in her local public hospital four months ago.

Speaking to Mamamia, she said the only out-of-pocket costs she had were for two visits to her non-bulk billing G.P. and excess on three ultrasounds. Total cost: $250.

Jennifer said the fact she had to pay so little to bring her baby into the world avoided an "enormous stressor" at an already expensive time: "not having to stack on the cost of healthcare is an enormous relief."

She was also able to access Midwifery Group Practice; a model of care offered in her local health district that involves being looked after by a group of midwives who are available to you throughout the process, from pregnancy to birth and postnatal care.

"I'd met them all before before being in labour," she said. "Of course, you never know who's going to be [working] on the day you actually have the baby. But it turned out I knew that midwife as well... It's nice that you have a pre-existing relationship. They know about the things you're worried about before having a baby, so they can help you through those things afterwards."

Jennifer notes that not all public hospitals offer this service, and if they do spaces are typically limited.

For the birth of her little one, Jennifer was in hospital for three nights due to emergency surgery for removal of her placenta after a large bleed. While she described the level of care she received as "amazing", she conceded it was difficult sharing a room (which wouldn't likely occur in a private hospital).

"It's a vulnerable time, there are visitors and you're emotional. It's also loud with babies and you're trying to keep noise down. You want to be really understanding that there's other people around," she said. "Although it's this small thing, I think it's a huge consideration. Certainly, had I known I was going to be staying in hospital, I think I would have thought about [private cover] more.

"But I'm still really glad that I went the way that I did."

"Eye watering" to "I didn't pay a thing": Aussie women share their bill.

Mamamia heard from several mothers about the fees associated with the birth of their child, both in the public and private hospital settings. Here is a range of their responses:

Kaela, private hospital: "I think about $5,200 all up, plus ultrasounds. Eye-watering, but I was in my hospital weekly for monitoring, and the level of service we got was incredible compared to friends in the public system."

Anja, public hospital: "I had two babies in the public system, and didn't pay a thing!"

Jane, private hospital: "I’ve had three children in our local private hospital going through a private obstetrician. Her fees were $2500 for my first two children, but it had gone up to $3000 for my third child this year. Plus, the anaesthetist to provide an epidural for my first birth also had out of pocket costs. There were also out-of-pocket costs for scans and blood tests."

Jo, public hospital (regional): "I didn't pay a cent. I saw my G.P., enrolled in the community midwife program, went to the pre-birth class, gave birth in the birthing suits — I was induced for both — and spent a night in hospital in my own room. Once home, I had three midwife visits in a week, and went to the lactation clinic. And it was all covered under Medicare."

How to avoid bill shock.

Ultimately, it's a very personal decision. One that parents should be reached in consultation with their G.P.

But for those who opt to take the private route, Assoc. Prof. Callander advises that they speak to their provider.

"Women need to ask what the estimated total cost is going to be," she said. "Not just 'how much is your standard antenatal consultation going to be?' but 'How much do you think I'm going to be paying out-of-pocket over the entire journey?'

"There's going to be a lot of variation in the volume of care the woman receives and the types of services she's charged for. So women really need to ask the question more often."

The information in this article should not be substituted for professional, personalised health advice. For advice and information relating to your perinatal care, speak to your G.P. or health professional.

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