Change in costs to funders of maternity care over time: an analysis of Queensland births
Bonnie Eklom
A , Sally Tracy B and Emily Callander A *
A Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
B The Molly Wardaguga Research Centre, Charles Darwin University, Darwin, NT, Australia.
Australian Health Review 47(2) 148-158 https://doi.org/10.1071/AH22108
Submitted: 28 April 2022 Accepted: 11 January 2023 Published: 7 February 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Objective To describe change in costs to different funders over time for women giving birth in Queensland between 2012 and 2018.
Methods A whole-of-population linked administrative dataset was used that contained all health service use in Queensland for women who gave birth between 1 July 2012 and 30 June 2018 and their babies. Aggregated costs for mother and baby from pregnancy to 12 months postpartum were used to compare the change in costs to funders over time.
Results There was an increase in mean total cost to all funders per birth in the public system and private system from 2012 to 2018. North West Hospital and Health Service (HHS) had the highest mean total cost (in Australian dollars) in 2018 (A$42 353), while home births had the lowest (A$6105). For the majority of HHSs the proportion of births with a positive birth outcome (as defined by a composite outcome measure) has remained largely static or declined during this time period. Cairns and Hinterland HHS and Townsville HHS had the largest declines of 15% and 16% respectively, while mean total cost to all funders rose 36.39% and 46.41%, respectively.
Conclusions There has been an increase over time across Queensland in the cost of childbirth in public hospitals and in the private system, while the cost of home birth has remained static. For most HHSs this increase in cost is also associated with little change or a decline in the percentage of births with a positive outcome. Increases in cost are therefore not being translated into better outcomes for women and their babies. Routine performance monitoring of cost, quality and safety should be adopted to ensure the provision of high value maternity care in Australia.
Keywords: administrative data, efficiency, maternity care funding, maternity services, performance monitoring, perinatal care, postpartum, pregnancy.
References
[1] Kennedy HP, Balaam M-C, Dahlen H, et al. The role of midwifery and other international insights for maternity care in the United States: an analysis of four countries. Birth 2020; 47 332–345.| The role of midwifery and other international insights for maternity care in the United States: an analysis of four countries.Crossref | GoogleScholarGoogle Scholar |
[2] Organisation for Economic Cooperation and Development (OECD). OECD health statistics 2021. Paris: OECD; 2018.
[3] Independent Hospital Pricing Authority (IHPA). Bundled pricing for maternity care. Final report of IHPA and the Bundled Pricing Advisory Group. Canberra: IHPA; 2017.
[4] Adams J, Steel A, Frawley J, et al. Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia. BMC Pregnancy Childbirth 2017; 17 114
| Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia.Crossref | GoogleScholarGoogle Scholar |
[5] Callander EJ, Topp S, Fox H, et al. Out-of-pocket expenditure on health care by Australian mothers: lessons for maternal universal health coverage from a long-established system. Birth 2020; 47 49–56.
| Out-of-pocket expenditure on health care by Australian mothers: lessons for maternal universal health coverage from a long-established system.Crossref | GoogleScholarGoogle Scholar |
[6] Callander E, Fox H. Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia. Aust N Z J Obstet Gynaecol 2018; 58 362–365.
| Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia.Crossref | GoogleScholarGoogle Scholar |
[7] Yu S, Fiebig DG, Scarf V, et al. Birth models of care and intervention rates: the impact of birth centres. Health Policy 2020; 124 1395–1402.
| Birth models of care and intervention rates: the impact of birth centres.Crossref | GoogleScholarGoogle Scholar |
[8] Shaw D, Guise J-M, Shah N, et al. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet 2016; 388 2282–2295.
| Drivers of maternity care in high-income countries: can health systems support woman-centred care?Crossref | GoogleScholarGoogle Scholar |
[9] Tracy SK, Tracy MB. Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data. BJOG: Int J Obstet Gynaecol 2003; 110 717–724.
| Costing the cascade: estimating the cost of increased obstetric intervention in childbirth using population data.Crossref | GoogleScholarGoogle Scholar |
[10] Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare. The Fourth Australian Atlas of Healthcare Variation. Sydney: Australian Government; 2021.
[11] Australian Institute of Health and Welfare. National Core Maternity Indicators 2017 Summary Report. Canberra: Australian Government; 2019.
[12] Council of Australian Governments. National Health Reform Agreement. Canberra: Australian Government; 2011.
[13] Queensland Government. Non-urgent elective surgeries postponed. 2022. Available at https://statements.qld.gov.au/statements/94231 [verified 22 March 2022].
[14] Australian Institute of Health and Welfare. Public hospitals worked to clear elective surgery backlog during 2020–21. 2022. Available at https://www.aihw.gov.au/news-media/media-releases/2021/january-1/public-hospitals-worked-to-clear-elective-surgery [verified 20 March 2022].
[15] Australian Institute of Health and Welfare. The first year of COVID-19 in Australia: direct and indirect health effects. Canberra: AIHW; 2021.
[16] White J, Cavenagh D, Byles J, et al. The experience of delayed health care access during the COVID 19 pandemic in Australian women: a mixed methods exploration. Health Soc Care Community 30 e1384–e1395.
| The experience of delayed health care access during the COVID 19 pandemic in Australian women: a mixed methods exploration.Crossref | GoogleScholarGoogle Scholar |
[17] Australian Institute of Health and Welfare. Cancer in Australia 2021. Canberra: AIHW; 2021.
[18] Callander EJ, Fox H. What are the costs associated with child and maternal healthcare within Australia? A study protocol for the use of data linkage to identify health service use, and health system and patient costs. BMJ Open 2018; 8 e017816
| What are the costs associated with child and maternal healthcare within Australia? A study protocol for the use of data linkage to identify health service use, and health system and patient costs.Crossref | GoogleScholarGoogle Scholar |
[19] Eklom B, Tracy S, Callander E. An exploration of potential output measures to assess efficiency and productivity for labour and birth in Australia. BMC Pregnancy Childbirth 2021; 21 703
| An exploration of potential output measures to assess efficiency and productivity for labour and birth in Australia.Crossref | GoogleScholarGoogle Scholar |
[20] Council of Australian Governments Health Council. Woman‐Centred Care: Strategic Directions for Australian Maternity Services. COAG Health Council. 2019.
[21] Queensland Health. Clinical Services Capability Framework for Public and Licensed Private Facilities Maternity Module. Brisbane, Australia: Queensland Government; 2014.
[22] Queensland Health. Rural Maternity Taskforce Report. Brisbane: Queensland Government; 2019.
[23] Sudhof L, Shah NT. In Pursuit of Value-Based Maternity Care. Obstet Gynecol 2019; 133 541–551.
| In Pursuit of Value-Based Maternity Care.Crossref | GoogleScholarGoogle Scholar |
