西班牙高移民地区的分娩医疗保健费用描述性分析。
Descriptive analysis of childbirth healthcare costs in an area with high levels of immigration in Spain.
机构信息
Epidemiology and Evaluation Department, IMIM-Hospital del Mar, Barcelona, Spain.
出版信息
BMC Health Serv Res. 2011 Apr 15;11:77. doi: 10.1186/1472-6963-11-77.
BACKGROUND
The aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months). Costs were assessed by taking into account maternal origin and delivery type.
METHODS
We performed a cross-sectional study of all deliveries in a teaching hospital to mothers living in its catchment area between October 2006 and September 2007. A process cost analysis based on a full cost accounting system was performed. The main information sources were the primary care program for sexual and reproductive health, and hospital care and costs records. Partial and total costs were compared according to maternal origin and delivery type. A regression model was fit to explain the total cost of the childbirth process as a function of maternal age and origin, prenatal care, delivery type, maternal and neonatal severity, and multiple delivery.
RESULTS
The average cost of childbirth was 4,328€, with an average of 18.28 contacts between the mother or the newborn and the healthcare facilities. The delivery itself accounted for more than 75% of the overall cost: maternal admission accounted for 57% and neonatal admission for 20%. Prenatal care represented 18% of the overall cost and 75% of overall acts. The average overall cost was 5,815€ for cesarean sections, 4,064€ for vaginal instrumented deliveries and 3,682€ for vaginal non-instrumented deliveries (p < 0.001). The regression model explained 45.5% of the cost variability. The incremental cost of a delivery through cesarean section was 955€ (an increase of 31.9%) compared with an increase of 193€ (6.4%) for an instrumented vaginal delivery. The incremental cost of admitting the newborn to hospital ranged from 420€ (14.0%) to 1,951€ (65.2%) depending on the newborn's severity. Age, origin and prenatal care were not statistically significant or economically relevant.
CONCLUSIONS
Neither immigration nor prenatal care were associated with a substantial difference in costs. The most important predictors of cost were delivery type and neonatal severity. Given the impact of cesarean sections on the overall cost of childbirth, attempts should be made to take into account its higher cost in the decision of performing a cesarean section.
背景
本研究旨在估计西班牙巴塞罗那一家教学医院分娩的成本，包括产前护理、分娩和产后护理（3 个月）的成本。成本评估考虑了产妇的来源和分娩方式。
方法
我们对 2006 年 10 月至 2007 年 9 月期间居住在该教学医院服务范围内的所有产妇进行了一项教学医院分娩的横断面研究。采用完全成本核算系统进行过程成本分析。主要信息来源是初级保健计划的性健康和生殖健康以及医院护理和费用记录。根据产妇来源和分娩方式比较了部分和总费用。拟合回归模型以解释分娩过程总成本作为产妇年龄和来源、产前护理、分娩方式、产妇和新生儿严重程度以及多胎的函数。
结果
分娩的平均成本为 4328 欧元，母亲或新生儿与医疗机构的平均接触次数为 18.28 次。分娩本身占总成本的 75%以上：产妇入院占 57%，新生儿入院占 20%。产前护理占总成本的 18%，占总服务量的 75%。剖宫产的平均总成本为 5815 欧元，阴道器械分娩为 4064 欧元，阴道非器械分娩为 3682 欧元（p<0.001）。回归模型解释了 45.5%的成本变异性。与器械性阴道分娩相比，剖宫产的增量成本为 955 欧元（增加 31.9%），而器械性阴道分娩的增量成本为 193 欧元（增加 6.4%）。新生儿住院的增量成本从 420 欧元（14.0%）到 1951 欧元（65.2%）不等，具体取决于新生儿的严重程度。年龄、来源和产前护理在统计学上或经济上均无显著差异。
结论
移民和产前护理与成本差异无显著关联。分娩方式和新生儿严重程度是成本的最重要预测因素。鉴于剖宫产对分娩总成本的影响，应努力在决定进行剖宫产时考虑其更高的成本。
Zotero 插件