Public vs Private Hospitals for Pregnancy and Birth
I remember being newly pregnant with my first child. Flush with excitement and nerves, and COMPLETELY bamboozled with my first major decision – booking into a hospital, stat! Was it better to go for public or private hospital for giving birth in Australia? What were the pros and cons of both? How much did it cost? How was I supposed to choose?
I didn’t want to ask friends – the mere question would invite a barrage of raised eyebrows and knowing smiles (and we weren’t going to “announce” till being clear of the first trimester).
Most people I knew had given birth in private hospitals, which made me wonder why people weren’t choosing public hospitals. Was I completely crazy for even considering it?
I spent hours trawling pregnancy forums online, and reading about the experiences of many people – both good and bad. We ended up going with the public hospital system – and had a fantastic experience.
Having said that, there are situations, and personal circumstances, where going to a private hospital may be more beneficial or preferred.
If you’ve found yourself baffled when trying to make the decision between private or public hospitals for giving birth, then read on.
Disclaimer: this information is from my own experience and research of the private/public healthcare system in Australia. Depending on where you live, especially rural or regional areas, you should conduct your own research to determine what options are available to you. Always consult your GP for medical advice.
Public vs Private Pregnancy / Birth
What does “going public or private” for your hospital birth ACTUALLY MEAN?
Let’s start with the absolute basics.
Healthcare in Australia is either publicly funded by the government, or privately owned.
Australians are entitled to free healthcare, paid for by Medicare. If you have a Medicare number, you can be admitted as a public patient into a public hospital. You’ll be bulk billed, meaning it’s mostly free.
If you prefer, you can choose a private hospital instead. This generally means you can choose your specialist / doctor / caregiver. Choosing your own private doctor or hospital means you will be privately billed, which means you will be paying for your treatment.
Having private health insurance offsets some of the costs involved with being treated as a private patient.
While the Australian government encourages everyone to have private health insurance cover, even if you DO have private health insurance, you are STILL entitled to free treatment in a public hospital.
Also, you can be treated as a private patient (with your choice of doctor) in a public hospital.
How to choose between public or private hospitals for pregnancy
The internet can be a minefield of information, and completely overwhelming. Here’s some of the questions to ask yourself, when choosing between public or private hospital for pregnancy and maternity care in Australia.
- Cost of public vs private hospitals
- Do you want to choose your own hospital?
- Do you have a preference on your caregiver?
- Do you want continuity of care?
- What models of antenatal care are available to you?
- Is a single hospital room important to you?
- Do you have a preference towards an elective caesarean?
Cost of public vs private hospitals
This is a biggie, and often one of the first questions on everyone’s minds.
Do you have private health insurance?
In my younger years, I had little experience in being admitted to hospitals (for anything). I had blindly assumed that having private health insurance automatically meant you would just go to a private hospital.
So clear these things up:
- You don’t NEED private health insurance in order to be admitted to a private hospital. You can choose a private obstetrician and a private hospital, without insurance. You’ll just be up for the full bill. Since obstetricians (like all specialists) can set their own fees – this can be sky high. Though – ‘sky high’ can mean different things for different people. Having private health insurance will just cover some of the costs you would normally have to pay yourself.
- Having private health insurance does not mean you HAVE to go private – you can still choose to deliver in a public hospital. As anyone with a Medicare number is entitled to free healthcare in Australia, even if you have private health insurance, you can deliver your baby through the public system if you choose (more info later on how to help you decide!)
The arguments for having private health insurance (or not) are a different topic altogether, and aren’t covered here. It really depends on your own personal circumstances, health concerns, and financial situation. In general, having private health insurance assists with the the out-of-pocket costs for being treated at a private hospital; private hospitals mean you can choose your carer.
If you DO have private health insurance, and wish to use it for your pregnancy and delivery, check that your policy includes obstetrics. Many younger people may have cheaper insurance policies without obstetrics cover, as they have no immediate plans for starting a family.
If you planning on starting a family soon and want to upgrade your policy to include obstetrics, keep in mind that you may need to serve waiting periods to be eligible. Waiting periods for obstetrics is often 12 months.
How much does it cost to have your baby at a private hospital?
Again, before I did any research, I’d assumed that having private health insurance would mean that most of the costs involved would be paid for. I mean, surely that was the reason why they encourage us all to have private health insurance, right? Why they warn you to ensure your private health insurance covers you for pregnancy?
Sure, I knew that there’s always a ‘gap’ payment (insurance generally never covers the full amounts payable), but I’d kinda always assumed that it’d be, well – minimal.
I was a bit shocked to find out that giving birth in private hospitals can still end up costing a fair bit.
Having private health insurance with pregnancy cover does not cover the bulk of the costs associated with having your baby in the private hospital system. You should still expect to be out-of-pocket by $2,500-5000, at a minimum. Anecdotally, these costs could even go up to $10,000, or higher.
Why? Whilst your private hospital stay is mostly covered by insurance, you still have to pay private obstetrician appointment fees. In addition, they have “management fees”, payable once you reach a certain stage of your pregnancy. There’s also the cost for the actual delivery. Not to mention your ultrasounds, blood tests, any anaesthesia costs (if required).
Some private obstetricians may have agreements with certain health funds where you are covered for the ‘gap’ payment, or have a fixed amount to pay. You should always ask upfront what the expected costs are, to avoid any surprise bills at the end.
How much does it cost to have your baby at a public hospital?
If you go through the public hospital, your pregnancy care is more-or-less “free”, with the majority of costs being covered by Australia’s Medicare.
Your prenatal care, delivery, and postnatal care should all be covered, but you might still be up for up to $1000-1500 out of pocket, for things such as:
- ultrasound scans (dating or first trimester scans are more likely to be done privately. Your 24-week scan and beyond will likely be done for free at the public hospital)
- other pre-natal testing e.g. Nuchal Translucency (NT) scan, Non-Invasive Prenatal Testing (NIPT)
- antenatal classes
What about costs after your baby is born?
When considering things such as costs and private health insurance, also consider follow-up costs after the actual delivery.
Depending on the health of both you and your baby, you may require extended hospital stays, special care, or visits to paediatricians or other specialists.
Do you want to choose your hospital?
The thing with public hospitals in Australia are, like our public schools, you will fall into a ‘catchment’ area for a local hospital. If you go with public hospital, you will be limited to whichever public hospital where you fall into the catchment area.
If you are not happy with your local hospital – say, it doesn’t have the best reputation – then your choice may be down to going private, where you can choose the hospital.
We’re pretty lucky in Australia to have great medical facilities and staff in the public hospital system, generally. Research your local hospital to determine whether you’d be happy to give birth there. Talk to friends, neighbours, and take a tour of the maternity and delivery wards, if they’re available.
Something to consider is that often, even if you’re booked in for a private hospital, if there’s an emergency they may transfer you to the nearest public hospital anyway. Public hospitals are often better resourced with equipment and facilities for critical or complicated situations.
Types of antenatal care
Again, this is a bit of a big topic.
Do you have a preference on your caregiver?
It’s a generalisation, but typically the main 2 most common options for your caregiver are an obstetrician or a midwife.
To give birth in a private hospital, most women find themselves a private obstetrician. An obstetrician is a specialist in the medical care during and after pregnancy, and for delivering babies. They’re specially trained for dealing with high-risk pregnancies. If you experience complications during delivery, then your obstetrician is trained to perform interventions and caesareans.
In the public hospital system, your main caregiver for the duration of your pregnancy is likely a midwife. Midwives are health professionals who will provide care for you during your pregnancy, and for the first weeks after birth. They’re clinically trained for most aspects of a normal birth. If you require interventions during your delivery, they may be trained for some minor procedures, but if you require a caesarean your surgery will be performed by an obstetrician.
As mentioned, these are main options, however there are also many midwives who practice privately.
Some other questions you might ask yourself are:
- Do you have a high-risk or complicated pregnancy? Would you prefer more one-on-one specialised medical care from a private obstetrician?
- Do you have a preferred or recommended obstetrician? Which private (or public) hospitals do they work at?
- Do you have a preference whether your caregiver is male or female?
- Do you want a private doula? A doula will work alongside your primary caregiver, supporting you during pregnancy, labour and afterwards, in non-medical care.
Do you want continuity of care?
How important it is to you to have the same caregiver throughout the duration of your pregnancy, labour, and postpartum? While this doesn’t faze some people too much, this can be a major factor for some women.
There are benefits to this model of care, as your caregivers will be more familiar with your pregnancy and situation, and will be there for your delivery. Continuity of care may be especially beneficial if you have a high-risk pregnancy.
When booking a private obstetrician, midwife or doula will obviously follow a continuity of care model. They should be available for all your appointments, and will be on-call for your delivery.
In public hospital, the standard antenatal clinic option is unlikely to offer continuity of care – you will be seen by whichever midwives are on duty at the time. Continuity of care would be available if they have birth centre, midwifery group practice or team midwifery options.
Continuity of care – expect the unexpected
Even if you have dedicated caregiver, things can often not go to plan, which means you may have someone else on the day helping you to deliver your baby. Unexpected family or household emergencies can happen to anyone (we’ve all had a car breakdown at an inopportune time!), people get sick. And certainly, babies waiting to be born do not wait for anyone else’s schedule!
Your private obstetrician might not make it on time if you go into spontaneous labour. In which case a midwife at your private hospital may be there for your delivery.
Or in the public system, hospital policy may dictate the midwives cannot work more than a set number of hours each week. If they have attended multiple long deliveries that week, they may not be able to personally attend to your delivery. This happened to us, but we had the lovely midwives on duty look after us for the big moment with our second bub.
What models of antenatal care are available to you?
When giving birth at a private hospital, you’ll have your private obstetrician or midwife (and doula).
For public hospitals, there are some different models of care to choose from. It’ll be dependent on what your local hospital offers (not all will be available at all hospitals).
- Antenatal clinic – you will see whichever midwife or doctor is on duty, for your antenatal appointments. Your baby will be delivered by whomever is on duty at the time. This is the standard offering at public hospitals. Some downsides are that you won’t get to know your carers. Anecdotally there also seem to be longer wait times at the antenatal clinic.
- Midwifery Group Practice (MGP) – this might also be called Caseload Midwifery. You will be looked after by the same 2-3 midwives for your pregnancy. They’ll also be on call to deliver your baby. They’ll have the advice from other doctors and obstetricians to help throughout your pregnancy, if required. It’s nice to develop a relationship with the people who will deliver your baby (when you may be experiencing some nerves!) Being accepted into a MGP program can be dependent on availability, so make sure you enquire early! Some hospitals may only accept low-risk pregnancies also.
- Team Midwifery – this is similar to midwifery group practice. The difference is there may be more midwives within the team looking after you (up to 8).
- Birth Centre – these are best for those wanting natural birth and minimal interventions (that includes pain relief). Water birthing is an option at a birth centre, usually. Your care will be by midwives within the birth centre. They generally only accept women with low-risk pregnancies. Birth centres are in VERY high demand, and have very limited availability. I’ve seen jokes that you need to be booked in before even getting your positive pregnancy test! Birth Centres are usually attached to the public hospital, so you still have access to Emergency or greater pain relief, if required.
- Shared care – this is where your antenatal appointments are shared between the hospital clinic, and your GP. This may be a benefit if you already have a close relationship with your existing GP. Or possibly those in remote areas who are located closer to their GP.
Your local hospital may have other models of care as well. Some hospitals have special programs for high risk pregnancies, or even home birth.
I recommend researching the choices available at your public hospital early on, so you can decide what works best for you. You will have a better chance of getting your pick, if they have limited availability.
When calling the hospital to book in, be up-front if you have a particular model of care in mind. In my experience, they can be very busy and will assume you are booking in for the standard antenatal clinic. For Midwife Group Practice or other models of care, they may have a different process (e.g. finding out whether they have an availability for your estimated due date). So be clear on what options are available early on, so you can let them know your preference.
Is a single hospital room important to you?
In private hospital, you’re pretty much going to have a private room to yourself. There might even be the option for your partner to stay overnight with you!
The obvious benefits are for potentially more rest (heck, they don’t call it ‘labour’ for no reason). Not to mention some much wanted privacy in your earliest bonding hours with your newborn.
Often, your hospital stay at a private hospital tends to be a bit longer – up to 5 days after delivery.
If you decide to go with a public hospital, you should expect to share a room. Unfortunately this is possibly with up to 4 (or more!) mums and their newborn bubs.
This just means that peace and quiet may be a rare thing. Doctors and nurses will be doing their rounds, and there’ll be lots of people in the room during visitation times. Not to mention many crying babies adjusting to life outside of the womb. Rudely awakened from their warm and cosy uterine slumbers (haha).
This is just the reality, but the thing to remember here would be that it’s only a couple. In public hospital, you may stay from 1-3 days, depending on your circumstances. If you had a very straightforward delivery and it’s not your first baby, you might even be discharged after 4 hours!
In my experience, public hospitals have a strong focus on ensuring you are confident with breastfeeding, before they discharge you. You’ll also receive multiple home visits from your midwives in those first couple of weeks at home.
Using your private insurance for a room ‘upgrade’ in public hospital
In some public hospitals, you can actually use your private health insurance to cover your hospital stay. This means that you may be offered a private room, or at least a less-crowded room (twin-share).
This is what we did, and in my opinion is a great option. In our case we still didn’t pay anything (the hospital covered our insurance excess, which I hadn’t expected).
If you have the appropriate insurance coverage the hospital may ask if you are interested in participating in the program. After your delivery, if private or twin-share rooms are available, you may be in luck! They’ll get you to sign the paperwork and you’ll be assigned the room.
I like to think that it helps the hospital out a bit, as they can recover costs of your stay from your insurer.
Note that a private room is not guaranteed. Private rooms are always prioritised for those needing it (for example, those who have had a difficult birth, multiple births, etc). But you may still be offered a twin share room, using your health insurance. This is arguably better than being in a room with 5 or more recovering mums and their bubs!
I’ve never lucked out to have the private room, but have been offered a twin room for both my deliveries. I can’t say I slept particularly well nonetheless! But it offered a less busy room for my stay, for which I was grateful.
Do you have a preference towards elective caesarean?
Choices in how you deliver your baby is a very personal thing – again, this won’t be covered here. But if it is your first baby and you’re thinking you may prefer elective caesarean, you MAY be more supported in your decision at a private hospital.
In many public hospitals, elective caesareans may require medical grounds to do so (for example: breech birth, placenta praevia). If you’re considering elective caesarean, then ask your public hospital what their policies are for elective c-section. Their ability to grant your request may be dictated by state policy, as well as individual hospital policy.
Elective caesareans in public hospitals are common if you’ve had a previous difficult delivery. For example, if you had previously experienced difficult natural birth with resulting injuries, of if an emergency c-section was required. It’s likely that a planned caesarean for your subsequent birth may be recommended by your caregivers at a public hospital.
Anecdotally it seems that an elective caesarean option is certainly more common with a private obstetrician. You can discuss your preferences with them during your care, and if appropriate you’ll have your delivery date booked in.
I hope that this information helps cut the confusion when deciding between private or public hospitals for your pregnancy. If you have any other tips in how you made a decision, feel free to post below.
Disclaimer: this information is from my own experience and research of the private/public healthcare system in Australia. Depending on where you live, especially rural or regional areas, you should conduct your own research to determine what options are available to you. Always consult your GP for medical advice.
Sources: Health Direct – ‘Understanding the public and private hospital systems’. Raising Children Network – ‘Midwifery-led care’
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