Markovic Radomir, Anicic Radomir, Benkovic Sladjana, Matejic Bojana
Clinic for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia.
Faculty of Organizational Sciences, University of Belgrade, Belgrade, Serbia.
BMC Pregnancy Childbirth. 2025 Jul 21;25(1):780. doi: 10.1186/s12884-025-07889-2.
Maternity healthcare costs vary widely due to demographic, pregnancy-related, and clinical factors. Understanding the drivers of extreme costs is crucial for optimizing resource allocation and ensuring equitable access to quality maternal healthcare. This study aimed to identify factors associated with extreme hospital childbirth costs in a tertiary-level hospital in Belgrade, Serbia.
A cross-sectional study was conducted on 6,949 women who gave birth in 2019. Maternal age, parity, pregnancy characteristics, delivery method, anesthesia type, perinatal interventions, and comorbidities were analyzed. Costs were categorized as expected or extreme, and multivariate logistic regression identified significant predictors of extreme costs.
In our study, 4.1% of mothers required extreme-cost hospitalization and treatment, and these extreme costs were significantly more prevalent among older women, first-time mothers, preterm births, and pregnancies ending in cesarean section. Mothers with extreme costs had a median hospital stay of 23 days compared to 5 days for those with expected costs (p < 0.001). The median total cost of maternity healthcare was 604.3 USD. Women undergoing cesarean delivery had four times higher odds of incurring extreme costs compared to those with spontaneous vaginal delivery.
Identifying cost-driving factors in maternity healthcare can improve financial planning and resource distribution in tertiary healthcare settings. Strategies to reduce unnecessary interventions, improve prenatal risk assessment, and optimize hospital stays should be explored to balance cost efficiency with high-quality maternal healthcare.
由于人口统计学、妊娠相关因素和临床因素，孕产妇医疗保健成本差异很大。了解极端成本的驱动因素对于优化资源分配和确保公平获得优质孕产妇医疗保健至关重要。本研究旨在确定塞尔维亚贝尔格莱德一家三级医院中与极端分娩成本相关的因素。
对2019年分娩的6949名妇女进行了横断面研究。分析了产妇年龄、产次、妊娠特征、分娩方式、麻醉类型、围产期干预措施和合并症。成本分为预期成本或极端成本，多因素逻辑回归确定了极端成本的显著预测因素。
在我们的研究中，4.1%的母亲需要极端成本的住院治疗，这些极端成本在老年妇女、初产妇、早产和剖宫产分娩的孕妇中更为普遍。极端成本的母亲中位住院时间为23天，而预期成本的母亲为5天（p<0.001）。孕产妇医疗保健的中位总成本为604.3美元。与自然阴道分娩的妇女相比，剖宫产妇女产生极端成本的几率高出四倍。
确定孕产妇医疗保健中的成本驱动因素可以改善三级医疗机构的财务规划和资源分配。应探索减少不必要干预、改善产前风险评估和优化住院时间的策略，以在成本效益与高质量孕产妇医疗保健之间取得平衡。
