Fall-off in private deliveries

Increasingly, expectant mothers are switching to the public system for maternity care, writes FIONA REDDAN

FOR MANY women, delighted at seeing that thin blue line appear, the next step was to make a discreet call to a private obstetrician to book in their pregnancy. Now, however, most pregnancy tests are digital and that call made in haste is also a thing of the past, as more and more women opt out of private maternity care and take their chances on the public sector.

Latest figures from some of the country’s major maternity hospitals show that more and more women are foregoing costly private care in favour of free care in the public system.

Take the Coombe hospital in Dublin for example. In 2007, some 2,065 women opted to attend the hospital privately to deliver their babies, with 1,416 choosing the semi-private option according to a spokeswoman. Over at the National Maternity Hospital (NMH) on Holles Street, 1,869 women opted for private care, with 2,255 choosing semi-private.

Five years and one unprecedented recession later, however, and it’s a very different story. Private numbers at the Coombe have plummeted, declining by almost 50 per cent from 2007 to 2011, down to 1,191. At the NMH, the number of private patients has also declined, down by 30 per cent to 1,294.

Despite the fact that many of these mothers would have private health insurance, the additional costs of seeing a consultant privately – which can come to €4,000 in Dublin – is now seen as too steep. This is particularly so given that the tax deduction has been reduced to 20 per cent, and most insurers only provide a minimum contribution, of about €500 at best, towards the cost of these fees.

And surprisingly, these expectant mothers, many of whom would be professionals and would traditionally have been expected to pay to see a consultant privately or would have done so for previous babies, are also choosing not to spend money on a semi-private option.

Semi-private is not available in all maternity hospitals across the country, but where it is, it typically means that care is delivered by a consultant-led team at a clinic in the hospital you have booked into. Usually, there is no commitment that you will be seen by the same consultant at each visit, nor will they attend the birth.

At the Rotunda in Dublin for example, semi-private care costs between €1,498 to €1,645, depending on the delivery option with some – but far from all – of this expense reimbursed by private health insurers. Semi-private at the NMH typically leaves patients with private health insurance out of pocket to the order of about €900, with pathology charges of €105 also to be paid, depending on health insurance cover.

According to figures from the Coombe for 2011, the numbers opting for semi-private care have fallen by a third from 2007, down to less than 1,000 patients in 2011, although it has more or less held up at the NMH.

With fewer women opting for some form of private care, this is putting more pressure on the public system – and less money in the coffers of the hospital as well as the pockets of the consultants. At the NMH for example, the numbers opting for public care have risen by almost 30 per cent since 2007, and now represent 61 per cent of all patients at the hospital, compared with 51 per cent back in 2007.

One additional factor behind the rise in public patients might also be the range of options now available, which range from combined care which involves your GP, to midwife-led care.

One care centre that has been affected more than most is Ireland’s only private maternity hospital, Mount Carmel, as expectant mothers began to shirk the costs – which could top €10,000 – of delivering in the hospital.

As a result, Áine Martin, business development manager at the hospital, points out that it has adapted its services to suit these challenging times. Under its shared care package, an expectant mother will get six visits to their local GP, which is covered under the State’s maternity scheme, as well as five consultant visits, three scans, and blood tests. The package starts at just €1,395, but you should note that depending on your insurance policy, the total costs might end up being north of this, as accommodation costs might not be fully covered by your insurance provider, even on a semi-private basis.

According to Martin, this shared care option is proving to be particularly attractive for mothers-to-be who fear overcrowded public hospitals. As a result, numbers are increasing in the hospital because of this option. “We have a number of patients who would have attended a public hospital privately before, but are now going to Mount Carmel on semi-private,” she notes.

The other option for mothers-to-be at Mount Carmel is consultant-led care, which involves unlimited visits to a consultant. Those looking for more personalised care, or those with health issues, might favour such an option but it does add up. Consultant fees are similar to those charged in Dublin’s public hospitals, ranging from about €2,900 to €3,500, but the cost of accommodation typically exceeds that covered by the private health insurers which can leave a significant shortfall.

Another indicator of the numbers of women dropping out of private care is the increasing number of private ultrasound scanning facilities popping up all over. With private care, the expectant mother is typically scanned on each visit, but in the public system, they can be few and far between. As a result, women now choosing the public route are “topping up” their care by paying for extra private scans.

At Ultrasound Dimensions in Dublin for example, an early scan costs €145, while an anomaly scan, which is undertaken at between 18 and 28 weeks, costs €165. In Limerick, prices start at €120 at MD Ultrasound, while at Babyscan in Cork and Dublin, an early scan costs from €99.

Finally, for those women willing to consider other options but still hoping to get that much-coveted private room when they have their baby, private health insurance won’t facilitate this.

Despite the fact you might have a policy which covers the cost of a night in a private room – which comes to €1,046 a night at the National Maternity Hospital, Holles Street – it is set out in legislation that you must attend a maternity hospital as a semi-private or private patient from the outset and can’t switch to avail of a private room at the end.