Changing models of public antenatal care in Australia: Is current practice meeting the needs of vulnerable populations? Stephanie J. Brown, PhD (Principal Research Fellow) a,b,n , Georgina A. Sutherland, PhD (Senior Research Fellow) c , Jane M. Gunn, PhD (Chair Primary Health Care Research) b , Jane S. Yelland, PhD (Senior Research Fellow) a a Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia b General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3053, Australia c School of Population and Global Health, University of Melbourne, Parkville, Victoria 3052, Australia article info Article history: Received 21 June 2013 Received in revised form 18 October 2013 Accepted 20 October 2013 Keywords: Antenatal care Patient experience Vulnerable populations abstract Objective: to investigate women's views and experiences of public antenatal care. Design: population-based survey in two states. Setting: South Australia and Victoria, Australia. Participants: 4366 women surveyed at 5–6 months post partum. Findings: of 8468 eligible women mailed the survey, 52% returned completed questionnaires. Fifty-seven per cent of women (2496/4339) received public antenatal care. Of these, half attended a GP for some/all antenatal visits, 38% attended a public hospital clinic or midwives clinic, and 12% had primary midwife care, mostly in a midwifery group practice. Women with complex needs – young women, those experiencing multiple social health problems, women of non-English speaking background, and women at higher risk of complications in pregnancy – were the least likely to say that care met their needs. Women attending a GP or midwife as a primary caregiver were the most positive about their antenatal care: 69% and 74% respectively describing their antenatal care as ‘very good’. Women attending a standard public hospital clinic were the least positive about their antenatal care with only 48% rating their care as ‘very good’. Women enroling in GP shared care or attending a midwives clinic at a public hospital gave intermediate ratings. Conclusion and implications for practice: Models of public antenatal care involving a designated lead primary caregiver (GP or midwife) came closest to meeting women's need for information, individualised care and support. & 2013 Elsevier Ltd. All rights reserved. Introduction Health systems in countries such as Australia, Canada, New Zealand and the UK are evolving rapidly, with implications for the way in which care is provided to women during pregnancy (UK Department of Health, 2007; Australian Government, 2008; Ministry of Health, 2008; Australian Government, 2009; Smith et al., 2009; Midwifery 2020, 2010). In Australia, changes to the organisation of maternity services have been driven by medical and midwifery workforce shortages, the introduction of casemix funding for public hospitals, financial incentives for hospitals to transfer care to community-based medical practitioners funded via Medicare (Australia's universal health insurance scheme), and an unexpected increase in the birth rate placing significant pressure on public hospital outpatient clinics (Dawson et al., 2000; Australian Government, 2008, 2009). Australian women can access antenatal care in either the public or the private sector. Care in the public sector is funded by both state and commonwealth governments. Visits to a public hospital are free, but there may be upfront costs associated with screening tests conducted outside a public hospital. Antenatal visits with community-based general practitioners (GPs) are partially funded under Medicare – Australia's universal health insurance scheme. It is possible for GPs to ‘ bulk-bill’ patients in which case the GP receives 85% of the schedule fee and patients incur no out of pocket costs. In practice, many women attending GPs for antenatal care are required to cover the gap between the fee charged and the amount that is reimbursed under Medicare. They may also incur similar gap fees for some routine tests in pregnancy. The last decade has seen a marked increase in the provision of collaborative models of care in the public sector, involving different combinations of care providers (midwives, general practi- tioners, obstetricians), sometimes co-located, but more often involving Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery 0266-6138/$ - see front matter & 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.midw.2013.10.018 n Corresponding author at: Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia. E-mail address: stephanie.brown@mcri.edu.au (S.J. Brown). Please cite this article as: Brown, S.J., et al., Changing models of public antenatal care in Australia: Is current practice meeting the needs of vulnerable populations? Midwifery (2013), http://dx.doi.org/10.1016/j.midw.2013.10.018i Midwifery ∎ (∎∎∎∎) ∎∎∎–∎∎∎