Anderson Karyn, Sadler Lynn, Thompson John M D, Edlin Richard
Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
Women's Health, Te Toka Tumai Auckland, Te Whatu Ora Health New Zealand, New Zealand.
Midwifery. 2025 Feb;141:104254. doi: 10.1016/j.midw.2024.104254. Epub 2024 Nov 27.
Women who receive midwifery continuity-of-care require fewer interventions, generating significant cost savings for health services. Existing cost models were based on studies including low-risk pregnancies, limiting generalisability.
New Zealand (NZ) is the only high-income country with a fully integrated midwifery continuity of care model facilitating study of real-world costs by model of care.
To compare healthcare utilisation and pregnancy-related public healthcare cost for private obstetricians and other community maternity caregivers (GPs, midwives), and planned caesarean compared to intended vaginal birth, within the NZ continuity-of-care maternity system.
Population-based cohort study including singleton pregnancies under private obstetrician and community maternity care with live birth January 2016 - June 2020. Administrative data were used to identify healthcare utilisation and associated cost for mothers and their infant(s) until 1 year post birth, using generalised linear model techniques.
248,424 singleton pregnancies were included. Adjusted mean costs were significantly higher for private obstetricians than community maternity caregivers (mostly midwives) ($1,096, 95 % CI $813 - 1,378). Elective caesarean section was more costly than intended vaginal birth ($4,316, 95 % CI $4,105 - 4,527). Within each intended mode of birth, pregnancies cared for by private obstetricians were more costly than community maternity caregivers.
Consistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences.
Funding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models.
Problem: Health systems seek to improve maternity care and contain healthcare budgets.
Women cared for by continuity-of-care midwives experience lower rates of preterm birth, obstetric intervention, and improved satisfaction compared to other models of care. It has been reported as cost-effective in a clinical trial setting among low-risk women.
This study uses real-world data from New Zealand, the only country with fully integrated midwifery continuity-of-care, to establish that midwifery care is cost-saving for public healthcare systems compared to maternity care provided by private obstetricians, when adjusted for obstetric risk factors.
接受连续性助产护理的女性所需的干预措施较少，可为医疗服务节省大量成本。现有的成本模型是基于包括低风险妊娠在内的研究，其普遍性有限。
新西兰是唯一一个拥有完全整合的连续性助产护理模式的高收入国家，这便于按护理模式研究实际成本。
在新西兰连续性护理产妇系统中，比较私人产科医生和其他社区产妇护理人员（全科医生、助产士）的医疗保健利用率及与妊娠相关的公共医疗保健成本，以及计划剖宫产与顺产的成本。
基于人群的队列研究，纳入2016年1月至2020年6月期间由私人产科医生和社区产妇护理并活产的单胎妊娠。利用行政数据，采用广义线性模型技术确定母亲及其婴儿在出生后1年内的医疗保健利用率及相关成本。
纳入248,424例单胎妊娠。私人产科医生的调整后平均成本显著高于社区产妇护理人员（主要是助产士）（1,096美元，95%置信区间813 - 1,378美元）。择期剖宫产比顺产成本更高（4,316美元，95%置信区间4,105 - 4,527美元）。在每种预期分娩方式中，由私人产科医生护理的妊娠成本高于社区产妇护理人员。
与现有文献一致，在对人口统计学和临床差异进行调整后，新西兰独立执业助产士的连续性护理成本更低。
在实施以助产士为主导的连续性护理模式时，资金结构和人群妊娠风险状况是重要的考虑因素。
问题：卫生系统寻求改善产妇护理并控制医疗保健预算。
与其他护理模式相比，接受连续性护理助产士护理的女性早产、产科干预率较低，满意度更高。在低风险女性的临床试验中，该模式已被证明具有成本效益。
本研究使用来自新西兰（唯一一个拥有完全整合的连续性助产护理的国家）的真实数据，证实与私人产科医生提供的产妇护理相比，经产科风险因素调整后，助产护理对公共医疗保健系统具有成本节约作用。
