EXCLUSIVE : Half of the babies that are delivered privately are billed as complicated births, a percentage that has surprised consumer health groups and questions the question of whether doctors are price gushes.
Medicare data show that of the 72,852 private births invoiced to Medicare in the 12 months between July 2017 and June 2018, 35,350 or 48 percent were billed as complex shipments.
Doctors claiming a complex delivery can bill patients nearly $ 1,000 than when they attend normal childbirth.
It comes as mother groups urge the government to introduce a bundled payment system for maternity care to take away the account shock that parents can pocket more than $ 10,000 for a private birth.
Medicare pays a higher reimbursement for complex births, either natural or by cesarean if the baby has breech presentation, underweight or the mother has high blood pressure, diabetes or other health problems.
Recent NSW data show that more than four out of ten babies born for private insured women have a cesarean section, many of these cesarean sections are elective subjects.
Royal Australian and New Zealand University of Midwifery and Gynecologist spokesman Dr Will Milford said one factor behind the high rates of complex births could be that women who had a private birth were usually older and therefore at risk of more complications.
Official data show that nearly half of all women are overweight or obese before they become pregnant, more than one in three have gestational hypertension and one in twelve has gestational diabetes.
These are factors that are likely to make their pregnancy more complex.
A recent evaluation by the government of Medicare benefits resulted in the tightening of the criteria that applied before doctors could claim a complicated delivery from November last year, Dr Milford said.
However, a review of Medicare data shows that billing for complicated deliveries has actually increased after those changes.
Between November 2016 and June 2017, 46.7% of the private births were billed as complicated compared to 48.9% between November 2017 and June 2018.
Dr Milford said that the new guidelines have also added conditions such as mental disorders as criteria for a complex delivery and this can also be an explanation for the increase in billing percentages.
In this case, the delivery itself may not be complicated, but the patient's overall health may well be, he said.
Because of the high deductibles charged by midwives and improved facilities in public hospitals, many women have abandoned the idea of giving birth in a private hospital.
The proportion of women who gave birth in private hospitals fell from 28.2 percent in 2006-07 to 24.2 percent in 2015-16.
Mrs Staines says it is time for the federal government to introduce a bundled payment system for maternity care comparable to that in New Zealand, the United Kingdom and Canada.
Bundled prices would mean that Medicare pays one price for a complete package of maternity care during the entire pregnancy from 10 weeks of pregnancy to six weeks after birth.
Such a scheme has been active in New Zealand for about 20 years, where the rate of growth of caesarean sections, forceps deliveries, inductions and epidural seizures and higher levels of patient satisfaction associated with the midwifery contracted model is lower.
The Independent Hospital Price Authority has examined such a payment system and recommended it last year, but the inability to trace an individual patient across multiple parts of the system means that it has not been approved.