Cost of maternity care to public hospitals: a first 1000-days perspective from Queensland
Emily J. Callander A E , Jennifer Fenwick B C , Roslyn Donnellan-Fernandez B , Jocelyn Toohill B D , Debra K. Creedy B , Jenny Gamble B , Haylee Fox A and David Ellwood AA School of Medicine, Griffith University, Southport, Qld 4215, Australia. Email: haylee.fox@jcu.edu.au; d.ellwood@griffith.edu.au
B School of Nursing and Midwifery, Griffith University, Meadowbrook, Qld 4131, Australia. Email: r.donnellan-fernandez@griffith.edu.au; d.creedy@griffith.edu.au; j.gamble@griffith.edu.au
C Gold Coast University Hospital, Southport, Qld 4215, Australia. Email: j.fenwick@griffith.edu.au
D Office of the Chief Nurse and Midwifery Officer, Queensland Health, Herston, Qld 4006, Australia. Email: j.toohill@griffith.edu.au
E Corresponding author. Email: e.callander@griffith.edu.au
Australian Health Review 43(5) 556-564 https://doi.org/10.1071/AH18209
Submitted: 10 October 2018 Accepted: 7 March 2019 Published: 15 July 2019
Journal Compilation © AHHA 2019 Open Access CC BY-NC-ND
Abstract
Objective This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies.
Methods A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services.
Results The mean unadjusted cost for each woman and her baby (n = 134 910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) –32%, –4%); women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51).
Conclusions There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs.
What is known about the topic? The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes.
What does this paper add? This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors.
What are the implications for practitioners? Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver.
Additional keywords: data linkage, efficiency, maternity services, performance monitoring, perinatal care, postpartum, pregnancy.
References
[1] Organisation for Economic Cooperation and Development (OECD). OECD health statistics 2018. Paris: OECD; 2018.[2] Bryant R. Improving maternity services in Australia: the report of the Maternity Services Review. Canberra: Office of the Commonwealth Chief Nurse and Midwifery Officer; 2009.
[3] Shaw D, Guise J-M, Shah N, Gemzell-Danielsson K, Joseph KS, Levy B, Wong F, Woodd S, Main EK. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet 2016; 388 2282–95.
| Drivers of maternity care in high-income countries: can health systems support woman-centred care?Crossref | GoogleScholarGoogle Scholar | 27642026PubMed |
[4] Australian Health Ministers’ Advisory Council. National framework for maternity services consultation draft. Canberra: COAG Health Council; 2017.
[5] Tracy SK, Tracy MB. Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data. BJOG 2003; 110 717–24.
| Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data.Crossref | GoogleScholarGoogle Scholar | 12892682PubMed |
[6] Tracy SK, Welsh A, Hall B, Hartz D, Lainchbury A, Bisits A, White J, Tracy MB. Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia. BMC Pregnancy Childbirth 2014; 14 46
| Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia.Crossref | GoogleScholarGoogle Scholar | 24456576PubMed |
[7] Toohill J, Turkstra E, Gamble J, Scuffham PA. A non-randomised trial investigating the cost-effectiveness of midwifery group practice compared with standard maternity care arrangements in one Australian hospital. Midwifery 2012; 28 e874–9.
| A non-randomised trial investigating the cost-effectiveness of midwifery group practice compared with standard maternity care arrangements in one Australian hospital.Crossref | GoogleScholarGoogle Scholar | 22172743PubMed |
[8] Australian Institute of Health and Welfare (AIHW). National core maternity indicators. Catalogue no. PER 58. Canberra: AIHW; 2013.
[9] Queensland Maternal and Perinatal Quality Council. Queensland mothers and babies 2014 and 2015. Brisbane: Queensland Health; 2017.
[10] Hunt R, Davey M, Anil S, Kenny S, Wills G, Simon D, Wallace E; on behalf of the Perinatal Safety and Quality Committee. Victorian perinatal services performance indicators report 2016–17. Melbourne: Safer Care Victoria, Victorian Government; 2018.
[11] Independant Hospital Pricing Authority (IHPA). National hospital cost data collection, public hospitals cost report, round 20 (financial year 2015–16). Sydney: IHPA; 2018.
[12] Women’s Healthcare Australasia. Benchmarking. 2018. Available at: https://women.wcha.asn.au/benchmarking [verified 1 October 2018].
[13] Australian Commission on Safety and Quality in Health Care (ACSQHC). Patient centred care: improving quality and safety through partnerships with patients and consumers. Sydney: ACSQHC; 2011.
[14] Australian Health Ministers Conference. National maternity services plan. Canberra: Commonwealth of Australia; 2011.
[15] Moore T, Arefadib N, Deery A, Keyes M, West S. The first thousand days: an evidence paper. Melbourne: Murdoch Children’s Research Institute; 2017.
[16] Callander EJ, Fox H. What are the costs associated with child and maternal healthcare within Australia? A study protocol. BMJ Open 2018; 8 e017816
| 29437751PubMed |
[17] Reserve Bank of Australia. Measures of consumer price inflation. 2017. Available at: https://www.rba.gov.au/inflation/measures-cpi.html [verified 1 October 2018].
[18] Australian Bureau of Statistics (ABS). Socio-economic indexes for areas (SEIFA) technical paper. ABS Catalague no. 2033.0.55.001. Canberra: ABS; 2011.
[19] Mesterton J, Lindgren P, Abreu AE, Ladfors L, Lilja M, Saltvedt S, Amer–Wåhlin I. Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study. BMC Pregnancy Childbirth 2016; 16 125
| Case mix adjustment of health outcomes, resource use and process indicators in childbirth care: a register-based study.Crossref | GoogleScholarGoogle Scholar | 27245845PubMed |
[20] Gao Y, Gold L, Josif C, Bar-Zeev S, Steenkamp M, Barclay L, Zhao Y, Tracy S, Kildea S. A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia. Midwifery 2014; 30 447–55.
| A cost-consequences analysis of a midwifery group practice for Aboriginal mothers and infants in the Top End of the Northern Territory, Australia.Crossref | GoogleScholarGoogle Scholar | 23786990PubMed |
[21] Tracy SK, Hartz DL, Tracy MB, Allen J, Forti A, Hall B, White J, Lainchbury A, Stapleton H, Beckmann M. Caseload midwifery care versus standard maternity care for women of any risk. Lancet 2013; 382 1723–32.
| Caseload midwifery care versus standard maternity care for women of any risk.Crossref | GoogleScholarGoogle Scholar | 24050808PubMed |
[22] Tracy SK, Welsh A, Hall B, Hartz D, Lainchbury A, Bisits A, White J, Tracy MB. Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes. BMC Pregnancy Childbirth 2014; 14 46
| Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes.Crossref | GoogleScholarGoogle Scholar | 24456576PubMed |
[23] Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev 2016; 4 CD004667
| Midwife-led continuity models versus other models of care for childbearing women.Crossref | GoogleScholarGoogle Scholar | 27121907PubMed |
[24] Donnellan-Fernandez RE. Midwifery group practice v standard hospital care: a cost and resource study. Aust Midwif News 2013; 13 9–11.
[25] Homer CS, Matha DV, Jordan LG, Wills J, Davis GK. Community-based continuity of midwifery care versus standard hospital care: a cost analysis. Aust Health Rev 2001; 24 85–93.
| Community-based continuity of midwifery care versus standard hospital care: a cost analysis.Crossref | GoogleScholarGoogle Scholar | 11357746PubMed |
[26] Donnellan-Fernandez RE, Creedy D, Callander E. Cost-effectiveness of continuity of midwifery care for women with complex pregnancy: a structured review of the literature. Health Econ Rev 2018; 8 32
| Cost-effectiveness of continuity of midwifery care for women with complex pregnancy: a structured review of the literature.Crossref | GoogleScholarGoogle Scholar | 30519755PubMed |
[27] Australian Institute of Health and Welfare (AIHW). Australia’s mothers and babies 2016 – in brief. Canberra: AIHW; 2018.
[28] Australian Institute of Health and Welfare (AIHW). Australia’s mothers and babies 2015 – in brief. Perinatal Statistics Series no. 33. Catalogue no. PER 91. Canberra: AIHW; 2017.
[29] Petrou S, Khan K. An overview of the health economic implications of elective caesarean section. Appl Health Econ Health Policy 2013; 11 561–76.
| An overview of the health economic implications of elective caesarean section.Crossref | GoogleScholarGoogle Scholar | 24155076PubMed |
[30] Australian Health Ministers’ Advisory Council. National maternity services plan 2014–2015 annual report. Canberra: Australian Health Ministers’ Advisory Council; 2016.
[31] The Lancet Stemming the global Caesarean section epidemic. Lancet 2018; 392 1279
| Stemming the global Caesarean section epidemic.Crossref | GoogleScholarGoogle Scholar | 30322560PubMed |
[32] Peters LL, Thornton C, de Jonge A, Khashan A, Tracy M, Downe S, Feijen‐de Jong EI, Dahlen HG. The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: a linked data population-based cohort study. Birth 2018; 45 347–57.
| The effect of medical and operative birth interventions on child health outcomes in the first 28 days and up to 5 years of age: a linked data population-based cohort study.Crossref | GoogleScholarGoogle Scholar | 29577380PubMed |
[33] Dahlen HG, Tracy S, Tracy M, Bisits A, Brown C, Thornton C. Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study. BMJ Open 2014; 4 e004551
| Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study.Crossref | GoogleScholarGoogle Scholar | 24848087PubMed |
[34] Sandall J, Tribe RM, Avery L, Mola G, Visser GHA, Homer CSE, Gibbons D, Kelly NM, Powell Kennedy H, Kidanto H, Taylor P, Temmerman M. Short-term and long-term effects of Caesarean section on the health of women and children. Lancet 2018; 392 1349–57.
| Short-term and long-term effects of Caesarean section on the health of women and children.Crossref | GoogleScholarGoogle Scholar | 30322585PubMed |
[35] Australian Institute of Health and Welfare (AIHW). Australia’s health, 2016. Canberra: AIHW; 2016.
[36] International Consortium for Health Outcomes Measurement (ICHOM). ICHOM pregnancy and childbirth data collection reference guide. Cambridge, MA: ICHOM; 2017.
[37] Australian Institute of Health and Welfare (AIHW). 25 years of health expenditure in Australia: 1989–90 to 2013–14. Canberra: AIHW; 2017.
