![Mothers-to-be are now paying far more in out-of-hospital costs than they were two decades ago.](http://web.archive.org./web/20180306075738im_/http://www.essentialbaby.com.au/content/dam/images/g/x/7/o/9/n/image.related.articleLeadwide.620x349.h0ibpa.png/1515975517642.jpg)
Pregnant women are paying 10 times more for obstetric services now compared with 25 years ago, in what a Queensland professor has described as a “massive increase” in costs.
The out-of-pocket Medicare Benefits Schedule costs of having a baby in Australia have increased over the past two decades by 1035 per cent, a James Cook University study found.
Using annual statistics published by the Department of Health for MBS services from 1984-2017, lead author and Associate Professor Emily Callander found an out-of-hospital obstetric service averaged at $264.98.
![James Cook University Associate Professor Emily Callander.](http://web.archive.org./web/20180306075738im_/http://www.essentialbaby.com.au/content/dam/images/h/0/g/y/o/h/image.related.articleLeadwide.520x294.h0ibpa.png/1515975517642.jpg)
Adjusted for inflation, an out-of-hospital service in 1992-3 averaged at $23.35.
Professor Callander said most of these services were associated with visiting an obstetrician either out of hospital in a specialist setting or in a private hospital, where an obstetrician was attending a birth.
“A price increasing by over 1000 per cent for out-of-hospital obstetric charges is a massive, massive increase,” she said.
“Compared to, say, in-hospital operations ... and other types of out-of-hospital specialist attendances, they have increased more gradually, whereas obstetrics have really increased far more rapidly.
“Women always have the choice whether to be treated publicly or privately, women can access care within the public hospital free of charge at the time of delivery, however, during the pregnancy they would still potentially face out-of-pocket charges.”
Australian Medical Association President and obstetrician Michael Gannon said changes in the medical field in the past two decades and increased professional indemnity insurance were likely behind the rise.
“Obstetricians have expenses the same as all other specialist doctors but where their costs are different - a lot employ a midwife in their rooms, that is a difference from a generation ago,” he said.
“It is regarded as best practice now for obstetricians to do postnatal depression screenings in their rooms. It is regarded as best practice to offer and provide antenatal vaccinations. All of those require staff to be employed.
“The biggest individual line item for an obstetrician is obstetricians pay more for professional indemnity insurance than any other speciality.
![Ms Ross said the costs of having Tom, 19, and Amelia, 17, were far less than when she was pregnant with Imogen, 11.](http://web.archive.org./web/20180306075738im_/http://www.essentialbaby.com.au/content/dam/images/h/0/h/9/2/2/image.related.articleLeadwide.520x294.h0ibpa.png/1515975517642.jpg)
“They pay probably 20 times what a GP does, 10 times more than an anaesthetist does, they pay four times what a surgeon does.”
He said that when comparing costs, the quality of care provided should also be compared, which he said had increased year-on-year.
“There seems to be a desire to pick on doctors in private practice one-on-one about the fees they are charging,” he said.
“Out-of-pocket expenses, to a large extent, reflect a freeze on patient rebate being frozen for seven years. The costs of running a practice don’t freeze at the same time.”
The study also found in-hospital costs had increased by 77 per cent over the same time period.
Brisbane mother-of-three and midwife Natalie Ross said the fee for an obstetrician during the labour and delivery of her first two children, aged 19 and 17, was $1200, of which Medicare covered about $300.
“Then when I had my next one, seven years later, the management fee had gone from about $1200 to $2400,” she said.
“I was surprised because it was a very big jump.
"In saying that, at that time in relation to the whole economy, everything was going up so much.
“Working in the field as a midwife, the management fee now can be up to $4500 to $5000, depending on obstetrician.
“Private health insurance won’t cover any of your management fees.”
Professor Callander found service charges in metropolitan areas were consistently above the national average, while the second-highest charge area was in remote areas.
Those living in outer regional areas had the lowest out-of-pocket expenses, according to the study.
Professor Callander called for services to be more transparent to allow women to shop around for affordable prices.
“If providers are transparent about the fees they charge, women can then shop around as they would with any purchase,” she said.
“There is not that transparency in healthcare so we are not able to see easily how much providers do charge for their service, so we are not able to easily shop around to make sure we get the best value for our money.
“It's not just within obstetrics, it is across healthcare in general. There isn’t a great deal of transparency with out-of-pocket charges.”
Dr Gannon said the “vast majority” were “completely transparent” about their fees.
“There is more than enough opportunity for women and their partners to obtain … [information about] obstetrician's fees. My fees can be posted, emailed or discussed over the telephone prior to the first appointment,” he said.