Personal-Finance

Maternity benefits without medical cover

2017-07-08 11:02

If a woman only joins a medical scheme after she has fallen pregnant, her child will be covered by the scheme, but not her medical costs during the pregnancy. That means if you fall pregnant without existing medical cover you have two options: either you rely on the state for your prenatal care and delivery, or you pay for private care. If you opt for private care it is difficult to know exactly how much your delivery costs will be. Even if you have quotes from the hospital and obstetrician, they won’t include complications or an emergency Caesarean.

The need for a more affordable and manageable prenatal and birthing plan for women not covered by a medical scheme led to the creation of The Birthing Team which, for a set cost, gives you access to a team of experts including GPs, mid-wives and obstetricians to provide holistic care during your pregnancy and delivery.

Dr Brian Ruff, CEO of healthcare management company PPO Serve who created The Birthing Team, believes that a team approach to pregnancy significantly drives down the cost of medical care.

“The high costs in the private sector are partly driven by high Caesarean rates which are often due to poorly managed patients as well as the fact that obstetricians are working on their own and have to schedule elective births as they cannot be available all the time,” says Ruff.

The company analysed the costs of pregnancy on low-cost medical schemes between 2014 and 2015 and found that the average cost, just for the mother’s medical bills, averaged R70 000 over the two years. “We looked at the data and found that the costs were driven by the 65% Caesarean rate and by women who developed diabetes, hypertension or depression during their pregnancy,” says Ruff, who believes that access to high-quality care during pregnancy through a team approach can reduce these complications, including for the baby. Women who do not have comprehensive medical cover are more likely not to access quality prenatal care and therefore face higher risks in labour.

The costs of giving birth

If you decide to give birth at a private hospital you can expect to pay R15 000 for a normal delivery. This excludes the doctor’s costs, anesthetist if you have an epidural, or any medication. The cost increases significantly if you end up having a Caesarean. This does not cover the costs of prenatal or postnatal care, which are significant.

In comparison, The Birthing Team package costs R19 500, which includes a minimum of eight antenatal visits, blood tests, basic medicines, short antenatal admission if required, the birth and six-weeks post-delivery care. The fee covers an emergency Caesarean if medically required.

Dr Howard Manyonga, head of The Birthing Team, says a woman pays an initial fee of R1 500 for the first assessment, which includes physical examinations, blood tests and scans and the development of a personalised care plan.

If she has a normal pregnancy with no foreseen health risks, the price would be R18 000 for the programme. This is payable over the course of the pregnancy and fully paid by 36 weeks. If a woman has health risks including HIV, diabetes or hypertension, then she would pay a higher premium of up to R27 000 to cover the additional medical supervision required.

“This price will not change, so you have certainty and would not need to pay out-of-pocket during the course of your pregnancy,” says Manyonga, unless the woman develops a serious health problem which is beyond the scope of the team to manage. This could include a pregnancy where a premature delivery requiring neonatal admission is likely, or the mother developing a serious condition that has significant risk for the pregnancy, such as cardiac problems. The patient would then be referred to a state hospital. “As we are not a medical scheme we cannot afford to cross-subsidise high-cost care. If we accept all the risk then the impact of just a few very high-cost cases would make the product unaffordable for others,” says Manyonga.

The Birthing Team has launched in Netcare Rand Hospital in Berea and will be launching in hospitals in Durban, Cape Town and Pretoria during the course of the year.

Next on City Press

Read News24’s Comments Policy

24.com publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
0 comments
Add your comment
Comment 0 characters remaining

September 24 2017