In Australia, women pay double what men do for health insurance. It doesn't make any sense.

Private health insurance. It's one of those adult things that sits alongside superannuation, taxes, and not eating m&m's for breakfast.

Figuring out what kind of policy you should go for, how much you need to set aside every month, and what level of cover you'll need is really important. And it's not necessarily an easy thing to decide. It's confusing. There's lots of jargon. 

And things only get more overwhelming (read: expensive) if you want to look after your reproductive health - something that seems to be strictly reserved for higher-tier policy holders. Which seems weird... because men automatically have their reproductive health covered, yeah?

Is it possible that health insurance providers charge you more because you're a woman?

Yes, it’s possible. And yes, it's already happening.

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Speaking to Mamamia, Associate Professor Gino Pecoraro, who is an obstetrician and gynaecologist in Brisbane, said women actually pay double what men pay for health insurance in Australia.

Yep, really.

"A gold policy (the only ones that cover pregnancy) is on average twice the price of entry-level bronze insurance policies. So, if women want reproductive care coverage, they have to pay effectively double what their male counterparts do (if they get a bronze policy - which covers their reproductive needs)," he said.

Professor Pecoraro said pregnancy is excluded from all but the top tier of policies, meaning insurance companies are effectively charging women a higher rate by stealth.

Image: Getty

As a result, Australian obstetricians say that the pressure on public maternity wards is mounting. 

That's why the National Association of Specialist Obstetricians and Gynaecologists (NASOG) is campaigning for a change. 

In a new petition, they're calling on the federal government and private health insurers to find a way for women to access cheaper pregnancy cover.

Why can't we make insurance fairer for women?

As you've probably guessed (gold star for you), it all comes down to one key thing: money.

According to Professor Pecoraro, one of the main arguments from insurance companies is that for them to continue to run profitable enterprises, they need to charge more for pregnancy cover, "even though they are making record profits," he adds. 

"The inclusion of pregnancy in every policy has been estimated to increase the cost per policy of up to 10 per cent. However, pregnancy is common and not always preventable - it should be part of the community rating system."

"Women are absolutely treated differently to men due to pregnancy or the POTENTIAL to become pregnant."

Hold up - so, women are expected to pay higher insurance premiums merely because their gender means they may become pregnant? Yes, this is a real thing that's happening.

"While prospective employers are not allowed to ask about an employee's plans to become pregnant when going for a job interview, insurers can and do - even though more than 50 per cent of spontaneous pregnancy in Australia is unplanned." 

"This same discrimination applies to men - they aren’t expected to pay higher premiums because they might impregnate someone."

Insurance companies also claim that men and women who are no longer of reproductive age, shouldn’t have to subsidise the costs of providing care to women who are pregnant.

Interestingly, however, women who purchase insurance policies automatically have cover for male-specific diseases (like testicular and prostate illnesses) and subsidise the costs of providing these services they will never need. 

Unlike women, men are not charged a different premium for the inclusion of specific male related conditions.

"Male-specific reproductive health issues are covered in cheaper policies," said Professor Pecoraro. "Robotic prostate surgery has large out-of-pocket costs for disposables etc., but prostate disease is covered in cheaper policies."

"The funds could offer differing amounts of rebates for pregnancy in the different tiers of insurance (leading to a higher out-of-pocket for those with cheaper policies). However, pregnancy as a condition should still be covered in every policy (meaning that the hospital bed would be covered and the fund would contribute to the Medicare numbers charged by caregivers), not just the uber-expensive ones." 

"Men do not get charged more if they want reproductive health care coverage."

Take Courtney Arana, for example, who spoke to Mamamia. "I'm a married woman, I can get pregnant. Why should I have to pay more for my insurance policy than men my age?"

"Men can get by with a cheaper policy that covers everything they need. I feel discriminated against just for being a woman," she said.

Courtney Arana. Image: Supplied

"Adding insult, I still face out-of-pocket expenses: several scans, the anaesthetist, the assistant surgeon and other bills for obstetrician fees my fund does not cover."

"I was forced to take out a higher tier of insurance just because I wanted to have a baby. The usual insurance policy doesn’t cover ANYTHING at all - and even when you do get the most expensive policy it really only covers the hospital bed. That’s fine if you are planning to get pregnant, but what if it is unexpected?"

The NASOG petition puts it like this:

"To give an example; if, as a result of an unplanned sexual encounter, a male with an entry-level insurance policy suffers medical complications, he is covered."

"If a woman from the same unplanned sexual encounter becomes pregnant, she does not enjoy health insurance coverage unless she is in the highest (and most expensive) tier of medical insurance policies and has completed the waiting time."

What does this mean for women's health?

According to Professor Pecoraro, the issue of inaccessible private health care is having a massive impact not only on the overall public health care system but also on the health of women. 

"This issue is specifically about private health insurance, but generally speaking, investment by government as well as private health insurance has been inadequate in the arena of women’s health for a long time," he said.

"That is why we are facing a crisis in maternity care with multiple smaller obstetric units closing causing women to have to travel larger distances in the bush to find a hospital where they can give birth, and the closure of multiple private obstetric services because they have become unaffordable."

The result? Fewer choices for women and an explosion of women needing to go to an underfunded and understaffed public facility, that's already filled to overcapacity.

This increased reliance on the public sector has many follow-on consequences.

"Public women are being “encouraged” to leave hospital sooner – as early as four hours after a vaginal delivery and 24 hours after an elective c-section," said Professor Pecoraro.

"This has been shown to increase postnatal depression rates and decrease breastfeeding rates. Also, all the extra work is left to fall on already overburdened general practice."

As a result, more women are presenting to already overburdened GPs with poor mental health.

"While public hospitals are free, fewer GP’s accept the bulk billing rebate as full payment - meaning that women have to either carry the extra cost or simply don’t keep the appointment, increasing the risk of missed diagnoses."

Image: Getty

Professor Pecoraro  said the public hospitals rely on registrars training to be specialists to staff their hospitals, however with 70 per cent of obstetric trainees having to work in the private sector when they finish, there aren’t any jobs for them in the public sector because they are too expensive. 

"If there aren’t any jobs for these trainees when they finish, why would new generations of junior doctors continue to apply for these jobs?"

"What we are seeing is that rural hospitals are needing to rely on locum specialists (at fees of around 2.5k per day) to fill these jobs. Ultimately it will cause problems for the public sector which the states can’t afford and so the federal government will have to intervene."

"Australia needs both public AND private sectors to work together, and unless something is done rapidly to fix this, private obstetrics will be a thing of the past."

What can be done?

"We have been arguing this point on a number of platforms for some time, said Pecoraro. "The final straw was when the anti-discrimination board wrote back to my patient, saying that they didn’t think this was sexual discrimination," said Professor Pecoraro.

"They patronisingly suggested to her that for it to be discriminatory, it had to specifically adversely affect women who were or could become pregnant. THAT IS EXACTLY WHAT IS GOING ON."

After reaching out to the Australian Human Rights Commission on the matter, Courtney received the below response:

"Discrimination can occur when someone is treated unfairly because of their sex or pregnancy, than a person of a different sex or who is not pregnant would have been treated in the same circumstances. It can also happen where there is a rule or policy that is the same for everyone but has an unfair effect on a person of a particular sex or who is pregnant, which is not considered reasonable in the circumstances. 

Unfortunately, it is not clear how your concerns could arguably be covered by the above definitions. It is not clear how you have been treated unfairly because of your sex or pregnancy.

Firstly, pregnancy is not necessarily a function of sex. In this respect, it is not clear that a woman who is not pregnant is treated less fairly than a man, for example.

With respect to pregnancy, it is not clear that direct discrimination could be argued as it is not clear you have been treated unfairly because of pregnancy or potential pregnancy. In terms of indirect discrimination, it is also not clear how you say the rule or policy would disadvantage you because of your pregnancy."

"They pretty much brushed my letter under the carpet and didn’t really care," Courtney told Mamamia.

Professor Pecoraro said this is why specialist doctors have started this petition - in order to get the federal government to look at the issue and reopen avenues of communication.

"I decided it was time for people power to force the government to do something about this situation. NASOG has been having meetings with the Federal Department of Health, looking at ways to try and save private obstetrics - and this issue was one of the three solutions we were offering." 

"While [Australian Minister for Health] Greg Hunt and his department were initially very supportive and we had multiple generally positive meetings, they recently stopped all communication with us."

"We feel that with a federal election looming and the liberal government being perceived as having an issue with the female constituency, this might be a good time to bring this issue to the fore."

If the federal government were to legislate that health insurance policies had to include pregnancy, Professor Pecoraro said it would then be up to the funds and market forces to find a way for them to keep their profits.

"I just don’t see a downside to it. Australia prides itself on its community rating for private health insurance, yet there is a glaring fault. The insurers argue they need to be profitable, but their earnings report suggests they are and the last lot of data suggests slightly more people are joining private health," he said.

"We need a vibrant private health sector to survive in Australia as the public system can’t (and was never designed to) provide ALL health care in our nation."

"We need those who can afford to pay for their health care to do so so that those who have no other choice can access care in the public system. All the data (from private health insurers themselves) tells us that having a baby is often the first time that private patients access the private system and if they are happy, will continue to access private medicine."

"If we can help people to afford private medicine, it will lessen the public burden, and ensuring that women don’t have to pay double for reproductive insurance is not only a sensible but FAIR way to do this."

For Courtney, the feeling of inherent discrimination drove her to help push the federal government to do better.

"It has just been accepted as the norm that if you require health insurance for pregnancy you have to pay top dollar with no justification... it needs to be investigated."

"All methods of contraception can fail, so women need to be reassured they will be covered if they unexpectedly fall pregnant. They shouldn't be penalised for bringing life into this world, it should be seen as a gift. 

"The government wants us to pay for healthcare and they encourage (if not, force) us to take it out - then we find that the most common reason young women need insurance isn’t covered. They make a big deal about being fair - but this just isn’t fair to women."

The peition, which Professor Pecoraro hopes will get people to start talking, can be found here.

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Feature image: Getty/Mamamia