William, Jananie
Description
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...[Show more] 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.
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