Emily Callander Public Lecture

Efficiency in maternity care - current variation and the opportunity of continuity of midwifery care

Presenter: Associate Professor Emily Callander

Associate Professor of Health Economics in the School of Medicine at Griffith University

• Tuesday, 16 April 2019
• 11.00 am
• Finance Decision Lab, Level 1, 4 Eastern Road, Macquarie University

Emily Callander is an Associate Professor of Health Economics in the School of Medicine at Griffith University. Her personal research interests are in maternal and early childhood health, particularly in using novel methods for measuring the equality and equity of health care and health outcomes, and the impact of health and health care on women’s living standards. This includes assessing women’s out of pocket costs, women’s economic resources and the distribution of women’s health outcomes across different socioeconomic groups using panel survey data and administrative data. She is leading a team of health economists who specialise in embedding these equity considerations, and patient perspective of healthcare costs and outcomes into the economic evaluation of health programs. She has strong quantitative analysis skills, with extensive experience in modelling health and healthcare costs using SAS. Her team has expertise in administrative data analysis, data linkage and biostatistics.

The current decline in private births is expected to continue across Australia. As more women are moving into public hospitals, the delivery of care in these institutions in a safe, effective, and economically sustainable manner is currently a key priority for public hospital planners and administrators. Using linked administrative data we have 1) compared costs for women giving birth in different public hospital services across Queensland and their babies; 2) estimated the potential cost-savings associated with increased use of continuity of midwifery care (COMC) for all-risk mothers.

The average unadjusted cost for each woman and her baby (n = 134,910) was $17,406 in the first 1,000 days. There was considerable variation in costs between hospital and health services (HHS) in Queensland for the costs of delivering maternity care, with the costs in the HHS with the highest costs 94% higher than the lowest cost HHS, after adjusting for clinical and demographic factors and birth type.

COMC relative to all other models of care was demonstrated to reduce the risk of caesarean section (RR 0.43, 95% CI: 0.38 – 0.56) and other interventions. We applied the rates of intervention risk reduction to a public hospital with 5,000 annual births, and only 10% of women currently receiving COMC and modelled the cost-saving estimated if 50% of women received COMC. Based upon the reduced risk of caesarean section 398 additional vaginal births would be expected at a cost-saving of $3.4 million per annum.

There is apparent variation in the efficiency of delivery maternity care across hospital sites. As such, refining the models of care that are used to care for women and their babies based upon efficacy and cost is a way of maximising the value of public maternity services. Continuity of midwifery care appears to offer health and cost improvements.

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