Blow-out in maternal healthcare costs unsustainable as rate of birth interventions increases

The paper

Callander EJ, Enticott JC, Eklom B, Gamble J, Teede HJ. The value of maternity care in Queensland, 2012-18, based on an analysis of administrative data: a retrospective observational study. Med J Aust. 2023 Dec 11;219(11):535-541. doi: 10.5694/mja2.52156. Epub 2023 Nov 8. PMID: 37940105.

What was this research about?

High-value maternal health care is care that provides the best experience for patients and care providers, as well as the best health outcomes and best value for money.

Pressure on health systems and budgets post-COVID, combined with increasing maternal age and obesity-related chronic diseases in mothers, mean it is becoming more challenging to provide high-value maternal health care with equal access for all women.

This paper analysed routinely collected administrative data in Queensland to monitor the value of maternity care in Australia, quantify changes over time in perinatal outcomes for women and their infants, and monitor maternity care costs.

What did the paper show?

The paper found the costs of maternal health services are increasing, without corresponding improvements in health outcomes.

The mean cost per birth in Queensland increased by 65% to $9,493 from 2012–2018. The total costs for all births increased from $1.31 to $1.84 billion, despite a slight decline in the annual number of births.

The proportion of births with non-positive outcomes rose from 27.1% in the second half of 2012 to 30.5% in the first half of 2018. More births involved maternal haemorrhage or birth trauma, while the proportion of spontaneous vaginal births beyond 37 weeks declined from 44% to 36%.

What is the significance of these findings?

These Queensland data can be extrapolated to the rest of Australia. This means we can estimate the cost of maternal health services nationally increased by $3 billion between 2012 and 2018. Continuing cost increases of this magnitude are not sustainable.

The data show these cost increases are largely being driven by increasing use of birth interventions such as caesarean section, and by increasing rates of preterm birth. Neither of these can be explained by the increasing age of mothers alone.

What happens next?

To maintain high-value maternal health care, we urgently need to ensure the provision of care that maximises health benefits for women and newborns despite increasing complexity.

The findings of this paper will inform studies into ways of improving value in maternal health services, for example by providing continuity of midwifery care.