Hanley Gillian E, Lee Lily
J Midwifery Womens Health. 2017 Sep;62(5):607-613. doi: 10.1111/jmwh.12643. Epub 2017 Sep 20.
Spending on care in childbirth represents a sizable portion of health care budgets. This has engendered a growing interest in potential clinical tools that could be used to improve patient experience and population health at a lower cost. A possible such tool is continuous support in labor from a trained doula, as doula care can decrease the likelihood of cesarean birth, epidural analgesia, and assisted vaginal birth. In addition, there is some emerging evidence suggesting that involving doulas in prenatal care can reduce rates of preterm birth.
We used data on the associations between doula care and these outcomes derived from a Cochrane review of continuous labor support to create an economic model of universal doula support in the Canadian province of British Columbia. These relative risks were used to estimate procedure reductions and the resulting cost savings using data on the number of relevant procedures performed from Perinatal Services BC coupled with cost information from the Canadian Institutes for Health Information.
For the calendar year 2013, we estimated savings in Canadian dollars (CaD) of CaD $10,428,171 (95% confidence interval [CI], $5,430,650-$14,434,740) if every low-risk birth were attended by a professional doula, not including the cost of the doula's services. Including reduction in preterm birth increases total savings to CaD $17,847,370 (95% CI, $6,772,341-$27,054,610). A professional doula providing labor support would yield an estimated savings of CaD $269.55 (95% CI, $141.70-$374.14) per low-risk birth or CaD $418.67 (95% CI, $158.87-$634.65) if including reductions in preterm birth. Any cost savings disappear at a doula reimbursement rate above CaD $418.67 per birth.
There is potential to reduce health care costs while improving patient experience and population health by providing universal doula coverage. However, our results suggest that reimbursement rates for doulas would have to be lower than the current range (CaD $300-$1500).
分娩护理费用在医疗保健预算中占相当大的比例。这引发了人们对潜在临床工具的日益浓厚的兴趣，这些工具可用于以较低成本改善患者体验和人群健康状况。一种可能的此类工具是由经过培训的导乐在分娩过程中提供持续支持，因为导乐护理可降低剖宫产、硬膜外镇痛和阴道助产的可能性。此外，有一些新出现的证据表明，让导乐参与产前护理可降低早产率。
我们利用了一项关于持续分娩支持的Cochrane综述中得出的导乐护理与这些结局之间关联的数据，来创建加拿大不列颠哥伦比亚省普遍导乐支持的经济模型。这些相对风险被用于估计手术减少情况以及由此产生的成本节约，使用的是来自不列颠哥伦比亚省围产期服务机构的相关手术数量数据以及来自加拿大卫生信息研究所的成本信息。
对于2013历年，如果每例低风险分娩都有专业导乐陪伴，我们估计可节省10428171加元（95%置信区间[CI]，5430650 - 14434740加元），不包括导乐服务的成本。包括早产率降低在内，总节省额增加到17847370加元（95% CI，6772341 - 27054610加元）。为低风险分娩提供分娩支持的专业导乐预计每例可节省269.55加元（95% CI，141.70 - 374.14加元），如果包括早产率降低则为418.67加元（95% CI，158.87 - 634.65加元）。当导乐每次分娩的报销率超过418.67加元时，任何成本节约都会消失。
通过提供普遍的导乐覆盖，在改善患者体验和人群健康的同时降低医疗保健成本具有潜力。然而，我们的结果表明，导乐的报销率必须低于当前范围（300 - 1500加元）。
