A Cost-Effectiveness Analysis of Low-Risk Deliveries: A Comparison of Midwives, Family Physicians and Obstetricians (original) (raw)
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Cureus, 2023
Introduction India is responsible for the second-highest maternal deaths and the greatest burden of stillbirths worldwide. The cost of intranatal services is an important determining factor, especially in developing countries like India. Most studies report the cost of delivery from the patient's perspective, but there is a lack of studies from the health system's perspective. This present study aimed to bridge this gap by estimating the overall and unit costs of various types of deliveries at a tertiary-level hospital in Rajasthan, India. Methods The cost estimation of intranatal services was conducted in a tertiary-level teaching hospital in Jaipur, Rajasthan. This cost analysis undertook the health system's perspective, using bottom-up costing methodology. Data on all the resources (capital/recurrent) used for the delivery of intranatal care from April 2020 to March 2021 were collected. Sensitivity analysis was done to account for any variability in cost components on overall intranatal service cost. Results The annual cost of intranatal care services at the tertiary care hospital was INR 149,011,957 (USD 1,988,152). The unit cost per vaginal delivery was INR 8,244.4 (USD 109.9) and the unit cost per cesarean section was INR 10,696.2 (USD 142.7). Among various heads of expenditure, 'human resource' costs were predominant, accounting for 47.7% of the total costs, followed by 'building/space' and 'overhead' costs, accounting for 30.59% and 11.1%, respectively. Conclusion The results may help plan and manage intra-natal care services in Rajasthan. Apart from the judicious utilization of resources, the findings of the study may also serve as a basis for future health economic studies.
Women's Health, 2015
International agencies have advocated scaling-up of midwifery resources as an important method for improving maternal health and reducing maternal mortality rates (MMR). The cost-effectiveness of midwife-led versus physician-led intrapartum care is an important consideration in the human resource planning required to reduce MMR. Studies suggest that midwife-led teams can achieve comparable effectiveness and outcomes using less medically intensive care compared with physician-led teams. In the absence of adequate medical cost data, decision makers should consider the substantially lower average costs for three main drivers: salaries, benefits and incentives (≥two-times lower); preservice training (three-times lower) and attrition (two-times lower) necessary to deliver intrapartum care at the level of midwife competencies. This suggests that scale-up of midwifery resources is a less expensive and more cost-effective way to reduce MMRs and could potentially increase access to skilled i...
BMC Pregnancy and Childbirth, 2010
Background: Public hospitals in developing countries, rather than the preventive and primary healthcare sectors, are the major consumers of healthcare resources. Imbalances in rational, equitable and efficient allocation of scarce resources lie in the scarcity of research & information on economic aspects of health care. The objective of this study was to determine the average cost of a spontaneous vaginal delivery and Caesarean section in a tertiary level government hospital in Islamabad, Pakistan and to estimate the out of pocket expenditures to households using these services. Methods: This hospital based cost accounting cross sectional study determines the average cost of vaginal delivery and Caesarean section from two perspectives, the patient's and the hospital. From the patient's perspective direct and indirect expenditures of 133 post-partum mothers (65 delivered by Caesarean section & 68 by spontaneous vaginal delivery) admitted in the maternity general ward were determined. From the hospital perspective the step down methodology was adopted, capital and recurrent costs were determined from inputs and cost centers. Results: The average cost for a spontaneous vaginal delivery from the hospital's side was 40 US$ (2688 rupees) and from the patient's perspective was 79 US$ (5278 rupees). The average cost for a Caesarean section from the hospital side was 162 US$ (10868 rupees) and 204 US$ (13678 rupees) from the patient's side. Average monthly household income was 141 ± 87 US$ for spontaneous vaginal delivery and 168 ± 97 US$ for Caesarean section. Three fourth (74%) of households had a monthly income of less than 149 US$ (10000 rupees). Conclusion: The apparently "free" maternity care at government hospitals involves substantial hidden and unpredicted costs. The anticipated fear of these unpredicted costs may be major factor for many poor households to seek cheaper alternate maternity healthcare.
Operational cost of the obstetrics unit of the Job Shimankana Tabane Hospital
2013
BACKGROUND: The World Health Organization (WHO) has acknowledged the importance of maternal care and listed it as part of its Millennium Development goals (WHO, 2002). The Maternity unit of the Job Shimankana Tabane (JST) Hospital, situated in the Rustenburg city (regarded as the fastest growing city within South Africa) is burdened with increasing number of patients for the last few years with resultant increased resource utilisation. However, there is no systematic study done to describe this situation. The above mentioned scenario necessitates this study to assess the operational cost of the Obstetrics Unit in relation to caseload, profile of patients, and resource utilization. AIM: To determine the operational costs within the Obstetrics Unit of the JST Hospital in terms of caseload, profile of patients, and resource utilization METHODOLOGY: Cross sectional study design was used for this study. Retrospective record review was done and information extracted from various sources of hospital information system. No primary data was collected for this study. Setting of this study was the Obstetrics unit at Job Shimankana Tabane Hospital situated within Rustenburg city of Bojanala District in North West Province. Data was collected on various variables that are relevant to the function of women health services and resource utilization in Obstetrics unit of this Hospital. Results: Obstetric unit of Job Shimankana hospital experienced high caseload due to patient bypassing primary health care service points including district hospitals with highest number being seen afterhours; and due to inappropriate referrals from clinics. Analysis of profile of these patients showed 93% being Africans, 90% unemployed; and 70% being single. Hospital obstetric unit operational costs amount to just over R1.3 million with 57% accounted for by goods and services and human resource accounting for the remaining 43%. The average was R7, 717.75, which is very high. Conclusion: The operational cost of this obstetric unit was found to be very high and quality may have been compromised due to increased caseload, leading to low length of stay. vi
Cesarean section rates and perinatal outcomes in resident and midwife attended low risk deliveries
European Journal of Obstetrics & Gynecology and Reproductive Biology, 1995
Cesarean section rates and perinatal outcomes of low risk pregnancies were evaluated in two different Turkish state hospitals. In this retrospective study, we compared cesarean section rates of 1668 low risk and non-private pregnancies managed by residents (group 1) and midwives (group 2), 53.3% and 46.6%, respectively. All patients belonged to a low socioeconomic class and none of them paid hospital costs themselves. Patient characteristics, mode of delivery and perinatal outcome information were studied by blind reviewers. Although patient characteristics and perinatal outcomes among the two groups were not statistically significant (P > 0.05), the cesarean section rate was three times higher in the resident group (9.88% vs. 3.08%) and this difference was statistically significant (P < 0.05). These findings suggest that reducing the expanded use of cesarean section for low risk pregnancies in teaching hospitals would not have an adverse effect on perinatal outcome.
The effects of prenatal care on cesarean section rates in a maternity and children’s hospital
Cumhuriyet Medical Journal, 2014
Aim. The aim of descriptive study was to determine whether women are receiving prenatal care services and if benefiting from prenatal care has an impact on the incidence of cesarean delivery. Methods. This descriptive and research was carried out at the Manisa Maternity and Children's Hospital with inpatients who had just given birth (n= 269). The data was collected with a questionnaire. The questionnaire consisted of two parts. The first part encompassed questions on the sociodemographic and obstetric characteristics of the women and the second part related to the prenatal care services that women received. Data was analyzed using the SPSS 15.0. Basic descriptive findings and the education provided as prenatal care services were analyzed using frequency distributions. Selected characteristics and mode of delivery were compared using qisquare analysis. Results. It was observed that 97% of the women participating in the study had received at least one prenatal care. Of the 8 women who had not received prenatal care (3%), only one (12.5%) had delivered by cesarean section. Cesarean rates were higher in women who received prenatal care four or more times in the pregnancy, in women who obtained the service only from doctors, in those who obtained it from private hospitals, and in women who had undergone ultrasound scanning. Moreover the study found that the education and training that comprised the content of prenatal care services were inadequate. Conclusion. According to the study quality of antenatal care prevent cesarean delivery which non-medical reasons.
American Journal of Obstetrics and Gynecology, 2014
We sought to assess the capacity to provide cesarean delivery (CD) in health facilities in low-and middle-income countries. STUDY DESIGN: We conducted secondary analysis of 719 health facilities, in 26 countries in Africa, the Pacific, Asia, and the Mediterranean, using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. RESULTS: A total of 531 (73.8%) facilities reported performing CD. In all, 126 (17.5%) facilities did not perform but referred CD; the most common reasons for doing so were lack of skills (53.2%) and nonfunctioning equipment (42.9%). All health facilities surveyed had at least 1 operating room. Of the facilities performing CD, 47.3% did not report the presence of any type of anesthesia provider and 17.9% did not report the presence of any type of obstetric/gynecological or surgical care provider. In facilities reporting a lack of functioning equipment, 26.4% had no access to an oxygen supply, 60.8% had no access to an anesthesia machine, and 65.9% had no access to a blood bank. CONCLUSION: Provision of CD in facilities in low-and middle-income countries is hindered by a lack of an adequate anesthetic and surgical workforce and availability of oxygen, anesthesia, and blood banks.
Open Journal of Obstetrics and Gynecology, 2015
Introduction: There has been an increase in the proportion of cesarean deliveries, especially in developing countries. Methods: Cross-sectional study of all hospital live births from mothers living in São Paulo Metropolitan Area, Brazil. Data were obtained from the Live Birth Information System, which is linked to the National Database of Health Establishments. Hospitals were classified as public, private or mixed. Descriptive analysis and exponential regression were conducted to evaluate time trends. Poisson regression was applied to analyze each hospital type to identify risk factors and the attributable risk fraction for cesarean section. Results: There was an annual increase (1.4%) of cesarean deliveries between 2000 and 2013. In 2009, the percentage of cesarean deliveries was 53% overall and 83% in private hospitals. The primary risk factor for cesarean delivery was delivery in a private hospital. Other risk factors that were stronger in public hospitals included the following: advanced maternal age, high maternal education, nulliparity, high number of prenatal visits, multiple pregnancy, hospital with low annual volume of deliveries, birth outside the city of residence and white skin color. Discussion: These results may be explained by the obstetric care model of private hospitals, which is not multiprofessional. Prenatal care and delivery are conducted by the same doctor and rarely include the input of another professional, such as a midwife. In addition, the mode of delivery influences the professional's payment.