The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia.

Birth Cost saving Models of care Planned homebirth

Journal

Women and birth : journal of the Australian College of Midwives
ISSN: 1878-1799
Titre abrégé: Women Birth
Pays: Netherlands
ID NLM: 101266131

Informations de publication

Date de publication:
29 Jul 2023
Historique:
received: 24 03 2023
revised: 17 07 2023
accepted: 19 07 2023
medline: 1 8 2023
pubmed: 1 8 2023
entrez: 31 7 2023
Statut: aheadofprint

Résumé

Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.

Sections du résumé

BACKGROUND BACKGROUND
Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications.
OBJECTIVE OBJECTIVE
This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria.
METHODS METHODS
We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD.
RESULTS RESULTS
In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders).
CONCLUSION CONCLUSIONS
A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.

Identifiants

DOI: 10.1016/j.wombi.2023.07.129 PMID: 37524616
pubmed: 37524616
pii: S1871-5192(23)00228-7
doi: 10.1016/j.wombi.2023.07.129
pii:
doi:

Types de publication

Journal Article

Langues

eng

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Conflict of interest None declared.

Auteurs

Yanan Hu (Y)

Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.

Jyai Allen (J)

Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia.

David Ellwood (D)

School of Medicine & Dentistry, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia.

Valerie Slavin (V)

Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia.

Jenny Gamble (J)

School of Nursing and Midwifery, Griffith University, Gold Coast, Australia; School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom.

Jocelyn Toohill (J)

School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom; Clinical Excellence Division, Queensland Health, Queensland, Australia.

Emily Callander (E)

Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. Electronic address: Emily.Callander@uts.edu.au.

Classifications MeSH