Academic journal article Australian Health Review

Impact of Private Health Insurance Incentives on Obstetric Outcomes in NSW Hospitals

Academic journal article Australian Health Review

Impact of Private Health Insurance Incentives on Obstetric Outcomes in NSW Hospitals

Article excerpt

Abstract

The purpose of this study is to analyse the impact of changes in Australian private health insurance coverage as seen in NSW'public and private hospital birth profiles, and identify trends in obstetric outcomes from 1997-2001. NSW Midwives Data Collection unit record data is analysed for women who gave birth to a live singleton baby of term gestation (≥37weeks) and cephalic presentation in NSW hospitals during 1997 - 2001. Use of private hospitals for childbirth has increased in conjunction with increases in private health insurance coverage. Although some obstetric interventions have increased for both public and private hospitals over time, clinical factors do not explain the large differences in birth interventions and outcomes between NSW public and private hospitals. Incentives to increase private health insurance coverage appear to be having a negative impact on childbirth, in terms of higher birth intervention and operative birth rates in NSW private hospitals.

Recent Health Insurance Incentives in Australia

From 1 July 1997, the Federal government introduced the first of what became a series of three major incentives with the aim of increasing rates of subscription to private health insurance. Incentives included means tested subsidies and tax surcharges, a 30 percent rebate on premiums and Lifetime Health Cover (LHC) (Butler 2002, Shorten and Shorten 2002). A recent figure of 3,146,000 persons covered is almost one million persons higher than the December 1996 figure of 2,200,000 (Private Health Insurance Administration Council (PHIAC) 2003). This suggests that due to the policy changes many more Australians will be using private hospitals. It is implicit in these incentives that Australians can expect health outcomes in private hospitals to be at least equivalent to public hospitals in terms of safety and quality.

Women using private health insurance for pregnancy, however, may be unaware that in doing so, they are increasing their likelihood of experiencing interventions such as cacsarean section, induction of labour, instrumental birth and episiotomy (Shorten & Shorten 1999, Roberts et al. 2000, Shorten & Shorten 2002). Given the potential negative health impact for women who experience intervention during childbirth (Brown & Lumley 1998, Johanson & Menon 1999, Enkin et al. 2000), analysis of the impact of changes in health insurance cover on public and private hospital obstetric outcomes is timely.

Concern has already been raised about obstetric funding whereby significant amounts are devoted to the majority of women at very low risk, and in particular those with private health insurance (Senate Community Affairs References Committee 1999). Referring to Hart's 'inverse care law', the report highlights the fact that many healthy women receive specialist obstetric care when there is no medical indication for it while more needy individuals receive lower levels of care (Hart 1971, Senate Community Affairs References Committee 1999). Pregnancy care is also unique in the expectation that women, mostly in the private sector but also to some extent in the public sector, will be encouraged to consult medical specialists for what are essentially primary health care services. (Senate Community Affairs References Committee 1999).

This study aims to present an analysis of changes in private health insurance coverage in terms of public and private hospital birth profiles and how they have impacted on trends in NSW hospital obstetric outcomes from 1997-2001. This will produce a clearer picture for analysis of the costs and benefits of the move to increase utilisation of private obstetric services.

Research Questions

* What is the impact of the increase in private health insurance membership during the period 1999-2001 on the proportion of women utilising private obstetric services for pregnancy and birth in NSW?

* What is the impact of recent changes in Australian health insurance on obstetric outcomes such as caesarean section rates, instrumental birth rates and perineal outcomes? …

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