Friday, March 6, 2009

Cost of midwife cover an obstacle,to homebirth service

From The Australian
Cost of midwife cover an obstacle,to homebirth service

Adam Cresswell, Health editor | March 05, 2009
Article from: The Australian

"SUBSIDISING indemnity payments for midwives could cost taxpayers an estimated $12 million to $24 million annually if the federal Government were to treat them as favourably as specialist obstetricians.

"Insurance experts warned yesterday that despite public perceptions that mothers who delivered their babies with a midwife faced fewer risks, premiums to insure midwives against bad outcomes were likely to be similar to those faced by obstetricians -- who can pay from $60,000 to $100,000 a year for their policies.

... continued

A calculation in this article that:
"... if a midwife performed 100 deliveries a year and charged $2000 each, earning $200,000, a $45,000 premium would exceed the 7.5 per cent threshold by $30,000.

"Existing federal subsidies for obstetricians cut in when the premium cost exceeds 7.5 per cent of the doctor's gross income. Above that threshold, the taxpayer picks up 80 per cent of the insurance cost."

The usual annual caseload that midwives who provide primary care through the pregnancy, birth and postnatal period, is approximately 40 women per year. If a midwife was not travelling much and had a partner who shared oncall times, she might be able to book 50 per year. I can't imagine 100! Upon my word, you would have to work like an obstetrician, do quick consultations, have *someone* (at present this role is filled by a midwife employed by the hospital) call you just in time so that you could show up for the birth, and not have much involvement in postnatal care. Oh, and btw, there are only approximately 200 homebirths per year in Victoria, and those are attended by 10 or more primary care midwives and a group of up to 20 'second' midwives.

As for the calculation being based on $2000 each, midwives around Melbourne are each charging between $2000 to $3000 for the whole package of care, from the initial consultation, through the postnatal home visits. We don't do 'deliveries' - the mother gives birth.

So here's the revised equation:
Each midwife attends 40 births per year, earning $2,500 each = $100,000
7.5% of $100,000 is $7,500.
A $45,000 insurance premium would require the government to subsidise 80% of $37,500 = $30,000.

["Dr Nisselle said that If midwives were granted the same deal as obstetricians, the subsidy would amount to $24,000 per midwife."]

"Official estimates have suggested between 500 and 1000 midwives would be needed to take pressure off existing birthing services, creating a potential subsidy cost of up to $24 million."

I hate to disagree with official estimates, but ONE midwife providing primary care on takes pressure off existing birthing services. That's pretty obvious. The Report of the Maternity Services Review estimates that there are 150 midwives currently self employed. Most are not fully employed - there simply aren't enough women willing to pay $2000-$5000 for the homebirth package (one or two midwives). But let's imagine for the sake of easy arithmetic that they were all fully employed, each earning $100,000 (which we are not), and the government subsidised each one by $30,000. That alters the amount the government would shell out to $30,000 X 150 = $4,500,000. Only a fraction of $24 Million.

Figures can be used in all sorts of ways, and I would not like to hold this calculation up as having any more meaning in the current debate than the published calculation I have quoted above. The total inequity of the monopoly of funds that medical professionals hold in maternity care defies belief. Why would the number crunchers and bean counters allow such an unwarranted haemorrhage of public money to continue? Noone is asking for extra government funding - just a more equitable use of the money, in allowing women to choose a midwife rather than a doctor. The number of pregnancy/birth episodes is not dependent on who provides the care.

Those who are interested in government support of midwifery need to understand that midwives and doctors do not do the same work. Doctors routinely require midwives to assist them in births; midwives don't require doctors unless complications arise. Doctors are surgeons and physicians; midwives are experts in working in harmony with each woman's own ability to give birth to her baby, promoting physiologically normal processes. A few women need doctors to get them pregnant; most don't. A few women need doctors to *deliver* their babies; most don't.

Joy Johnston


Janie said...

If the 37,500 is the ball figure that the government was to subsidise and they have expressed their decision NOT to fund homebirth then aren't they still in front on a per woman episode of care that they are not required to otherwise contribute to?

Joy Johnston said...

Good thought Janie.
I don't believe any decision has been made - the recommendations of the Review are only recommendations.
It's not as though midwives somehow create extra pregnancies. The indemnity costs for the women who employ a midwife would be moved from the doctor to the midwife.