Friday, April 24, 2015

Insurance: a pot of gold at the end of the rainbow

A pot of gold at the end of the rainbow?
A mirage?
The emperor's new clothes?
[My question is, when will we - the maternity community including midwives, hospitals, and consumers - wake up and come to terms with reality?]

Here's a thumbnail sketch of the insurance problem:

Professional indemnity insurance (PII) for all Australian health professionals became mandatory five years ago.
... BUT midwives who attend homebirth privately cannot purchase PII
... SO the exemption was introduced by the government, to enable midwives to continue being midwives.

Until recently, privately practising midwives who provide clinical midwifery services (pre-, intra-, and post-natal professional care) have purchased PII to cover pre- and post-natal services, and have, with certain conditions set down by the Nursing and Midwifery Board, come under the exemption for attending women in labour, birth, and the immediate postnatal period.  There were two insurance companies MIGA and Vero.  MIGA insurance is restricted to Medicare-eligible midwives, and includes cover for birth in hospital when the midwife has clinical privileges.  Vero, on the other hand, has provided an insurance product for midwives regardless of their eligibility for Medicare funding, and offers no cover for intranatal midwifery services.

Now, Vero has notified midwives that:
"It is with deep regret that we inform you that as of the 2nd April, 2015 Vero and Medisure will no longer be able to provide a Professional Indemnity Insurance policy to Private Practicing Midwives who are providing any home birthing or home birthing related services.

There are a number of factors that have impacted on this difficult decision, including:
• the high cost of claims that have resulted in the past 4 years
• the lack of government funding or assistance (for claims or premium costs), and
• the ability to offer an affordable policy to Private Practicing Midwives who are providing any home birthing related activities.

The Vero insurance product was the only PII option available to non-eligible midwives, and was seen by some eligible midwives as more affordable, and adequate to meet the requirements of registration.

I am not surprised that Vero has come to this decision.  The wonder to my mind was that someone thought it would be do-able!  The 'number of factors' dot points listed in the Vero letter are not surprising:
  • the high cost of claims that have resulted in the past 4 years
Yes, legal defence is costly.  That's what insurance is about.

  • the lack of government funding or assistance (for claims or premium costs), 
This is not new.  The product has never had government assistance

  • the ability to offer an affordable policy ...
This is not new either!

It has been clear to me, since privately practising midwives lost our insurance in 2001, that the private midwifery 'industry' cannot provide the sort of $$ required to insure birth.  Our annual earnings are of a similar quantum to the insurance premiums paid by obstetricians.  At that time I argued (unsuccessfully) in the then Nurses Board of Victoria that if insurance was to be mandated, there was an onus on the regulator/government to ensure that a suitable product was available and affordable.  If not, the regulator was effectively delegating its responsibility for protection of public interest through regulation of the midwifery profession to the insurer.

The purpose of statutory regulation of the health professions is protection of the public.  The insurer does not exist to protect public interest - in this case ensure safety for mothers and babies.  The insurer is a profit-making enterprise, and exists to protect the financial interests of its people - in this case midwives - and shareholders. 

When is the Australian government, the statutory regulator, and the whole maternity community going to stop chasing the pot of gold at the end of the rainbow?  When are they/we going to recognise the mirage of insurance, that in almost every case it makes no difference to any outcome for the client?

Readers who are interested in the back story and further discussion may check out these links:

Midwife Rachel Reed has recently updated her Midwife Thinking blog post on the Future of Midwifery and Homebirth in Australia.

Maternity Choices Australia (formerly Maternity Coalition) has documents and links at its website, and discussion at its facebook pages.