Why bundled payments fail maternity patients

BUNDLED payments are the slippery slope towards US-style managed care. Health insurers pre-determining what they will pay for regardless of the clinical needs of patients is not a "comprehensive care package" as claimed. In fact, it is the opposite, dictating care to specialists based on costs and leaving the most vulnerable patients at highest risk.

It can offer potential benefits for cost management, but the impact depends heavily on how it is implemented. When done in genuine close consultation with hospital treatment teams, bundling can promote coordinated, efficient care that benefits patients, hospitals and insurers.

But schemes imposed solely by insurers threaten to undermine the safety and quality of patient care. Bundling, dictated by health insurers, is just a bid to deny patients the individual care they need. That individualised care is why they have private health insurance in the first place.

Obstetricians rightly warn that bundling does not accommodate emergencies like C-sections or sudden complications, which often require urgent, high-level intervention. The risks are real: misclassification of pregnancies as 'low-risk' is common, yet such labels are inherently unreliable.

They make the case that defining 'low-risk' pregnancy in Australia is complex due to the dynamic nature of maternal and foetal health. Bundling is overly simplistic, failing to deal with the unpredictable and complex nature of individual patient needs.

Risk models tend to focus narrowly on outcomes like pre-term birth or uterine rupture, but neglect broader maternal morbidity and mortality, which can be heightened when care is overly rigid, as the insurance companies would like.

Research from the Australian Institute of Health and Welfare shows that even pregnancies initially classified as low-risk can rapidly develop complications, with approximately 17% of low-risk pregnancies experiencing issues, such as gestational diabetes or hypertensive disorders.

The consequences are dire. These flawed models lead to under-treatment, insufficient monitoring and increased emergency transfers, all further escalating risks. Even worse, when bundling is imposed without collaborative input, it can incentivise practitioners to scramble for obstetric support during emergencies, potentially delaying critical interventions.

Some specialists have voiced strong opposition, warning that schemes driven solely by insurers often prioritise cost-cutting over patient safety, while undermining transparency and quality.

Decreed solely by insurers, bundling payments risk becoming shortcuts that threaten patient safety. It is crucial that healthcare providers and insurers work together, rather than insurers unilaterally imposing schemes that do more harm than good to save a buck.

The condition that insurers must collaborate with treatment teams in designing bundled payment schemes is essential. Healthcare, especially during and after pregnancy, is too important to be compromised by insurer-led schemes that prioritise cost savings over patient wellbeing.

-ENDS-

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