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

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.