Maternal Health System Costs of Adverse Birth Outcomes

Abstract

Adverse birth outcomes can have an overwhelmingly negative impact on many aspects of society – the infant, mother and family are intimately affected, but there are also major consequences on the overall health system. For the purpose of this study, adverse birth outcomes were defined as: premature birth, low birth weight, congenital conditions, stillbirth and neonatal death. The few studies, based overseas, that have investigated the health system costs of women following adverse birth outcomes showed these costs were significant and needed to be addressed. To date, no such studies have been conducted with Australian data.

This thesis contributes to this area by quantifying the difference in maternal health system costs of women who experienced adverse birth outcomes and those that did not, using Australian data. The cost differentials were assessed across both hospital and out-of-hospital systems. In addition, statistical and actuarial techniques were employed on a comprehensive dataset – with linkages between various administrative data and longitudinal data collected on a large, broadly representative, sample of women. The techniques adopted in this study enabled an in-depth analysis of the complexities in the area, in particular the associations between risk factors and their impact on health system costs. These results were used to develop cost-effective health policy recommendations.

The results showed that the mean maternal health system cost differentials for adverse births were substantial at 23% and 27% for hospital and out-of-hospital costs, respectively. These amounts are broadly in line with the existing literature. The key cost risk factors were mode of delivery, use of In Vitro Fertilisation treatments, specialist and general practitioner use for perinatal services, private health insurance status, adverse births, area of residence, diabetes, smoking status and mental health factors.

The findings of this project showed that there were a number of key areas where health resources may be directed and smoking and mental health policy were considered further. With regard to smoking, programs providing incentives for smokers to quit during pregnancy have been found to produce successful outcomes and recommended for further consideration. For mental health, numerous mental health initiatives were recommended as a priority for attention. These included a national universal mental health screening protocol for antenatal and postnatal periods in conjunction with improved screening methods and health services that focus on holistic, proactive early intervention so that mental health problems are detected and treated early. While these recommendations are likely to require increased funding in some areas, the results of this study suggest they are worth exploring further as investing in preventative strategies are likely to reduce costs in the future when these women experience major life events such as the birth of a baby. Not only are the initiatives likely to be cost-effective, but more importantly, they are likely to improve the health outcomes for those women who are most at risk of experiencing these adverse conditions.