The impact of caregiver and intended mode of birth on the public cost of care: Cost analysis of maternity and neonatal care in New Zealand
Year: 2024
Type: article
Study design: Observational Study
Abstract: PROBLEM: Women who receive midwifery continuity-of-care require fewer interventions, generating significant cost savings for health services. Existing cost models were based on studies including low-risk pregnancies, limiting generalisability. BACKGROUND: New Zealand (NZ) is the only high-income country with a fully integrated midwifery continuity of care model facilitating study of real-world costs by model of care. AIM: To compare healthcare utilisation and pregnancy-related public healthcare cost for private obstetricians and other community maternity caregivers (GPs, midwives), and planned caesarean compared to intended vaginal birth, within the NZ continuity-of-care maternity system. METHODS: Population-based cohort study including singleton pregnancies under private obstetrician and community maternity care with live birth January 2016 - June 2020. Administrative data were used to identify healthcare utilisation and associated cost for mothers and their infant(s) until 1 year post birth, using generalised linear model techniques. FINDINGS: 248,424 singleton pregnancies were included. Adjusted mean costs were significantly higher for private obstetricians than community maternity caregivers (mostly midwives) ($1,096, 95 % CI $813 - 1,378). Elective caesarean section was more costly than intended vaginal birth ($4,316, 95 % CI $4,105 - 4,527). Within each intended mode of birth, pregnancies cared for by private obstetricians were more costly than community maternity caregivers. DISCUSSION: Consistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences. CONCLUSIONS: Funding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models. STATEMENT OF SIGNIFICANCE: Problem: Health systems seek to improve maternity care and contain healthcare budgets. WHAT IS ALREADY KNOWN: Women cared for by continuity-of-care midwives experience lower rates of preterm birth, obstetric intervention, and improved satisfaction compared to other models of care. It has been reported as cost-effective in a clinical trial setting among low-risk women. WHAT THIS PAPER ADDS: This study uses real-world data from New Zealand, the only country with fully integrated midwifery continuity-of-care, to establish that midwifery care is cost-saving for public healthcare systems compared to maternity care provided by private obstetricians, when adjusted for obstetric risk factors.
Source: Midwifery
Institutions: University of Auckland, Health New Zealand
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,300
OpenAlex ID: W4404763423