Descriptive analysis of childbirth healthcare costs in an area with high levels of immigration in Spain

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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.</p

Resonant magnetopolaron effects due to interface phonons in GaAs/AlGaAs multiple quantum well structures

Polaron cyclotron resonance (CR) has been studied in three modulation-doped GaAs/Al0.3Ga0.7As multiple quantum well structures in magnetic field up to 30 T. Large avoided-level-crossing splittings of the CR near the GaAs reststrahlen region, and smaller splittings in the region of the AlAs-like optical phonons of th AlGaAs barriers, are observed. Based on a comparison with a detailed theoretical calculation, the high frequency splitting, the magnitude of which increases with decreasing well width, is assigned to resonant polaron interactions with AlAs-like interface phonons

Strong three-level resonant magnetopolaron effect due to the intersubband coupling in heavily modulation-doped GaAs/AlxGa1-xAs single quantum wells at high magnetic-fields

Electron cyclotron resonance CR) measurements have been carried out in magnetic fields up to 32 T to study electron-phonon interaction in two heavily modulation-delta -doped GaAs/Al0.3Ga0.7As single-quantum-well samples. No measurable resonant magnetopolaron effects were observed in either sample in the region of the GaAs longitudinal optical (LO) phonons. However, when the CR frequency is above LO phonon frequency, omega (LO)=E-LO/(h) over bar, at high magnetic fields (B>27 T), electron CR exhibits a strong avoided-level-crossing splitting for both samples at frequencies close to (omega (LO)+ (E-2-E-1)1 (h) over bar, where E-2, and E-1 are the energies of the bottoms of the second and the first subbands, respectively. The energy separation between the two branches is large with the minimum separation of 40 cm(-1) occurring at around 30.5 T. A detailed theoretical analysis, which includes a self-consistent calculation of the band structure and the effects of electron-phonon interaction on the CR, shows that this type of splitting is due to a three-level resonance between the second Landau level of the first electron subband and the lowest Landau level of the second subband plus one GaAs LO phonon. The absence of occupation effects in the final states and weak screening or this three-level process yields large energy separation even in the presence of high electron densities. Excellent agreement between the theory and the experimental results is obtained

Resonant magnetopolaron effects in GaAs/AlGaAs multiple quantum well structures

A detailed experimental study of electron cyclotron resonance (CR) has been carried out at 4.2 K in three modulation-doped GaAs/Al0.3Ga0.7As multiple quantum well samples in fields up to 30 T. A strong avoided-level-crossing splitting of the CR energies due to resonant magnetopolaron effects is observed for all samples near the GaAs reststrahlen region. Resonant splittings in the region of AlAs-like interface phonon modes of the barriers are observed in two samples with narrower well width and smaller doping concentration. The interaction between electrons and the AlAs interface optical phonon modes has been calculated for our specific sample structures in the framework of the memory-function formalism. The calculated results are in good agreement with the experimental results, which confirms our assignment of the observed splitting near the AlAs-like phonon region is due to the resonant magnetopolaron interaction of electrons in the wells with AlAs-like interface phonons. (C) 1998 Elsevier Science B.V. All rights reserved

Strong resonant intersubband magnetopolaron effect in heavily modulation-doped GaAs/AlGaAs single quantum wells at high magnetic fields

Electron cyclotron resonance (CR) has been studied in magnetic fields up to 32 T in two heavily modulation-delta-doped GaAs/Al0.3Ga0.7As single quantum well samples. Little effect on electron CR is observed in either sample in the region of resonance with the GaAs LO phonons. However, above the LO-phonon frequency energy E-LO at B > 27 T, electron CR exhibits a strong avoided-level-crossing splitting for both samples at energies close to E-LO + (E-2 - E-1), where E-2, and E-1 are the energies of the bottoms of the second and the first subbands, respectively. The energy separation between the two branches is large, reaching a minimum of about 40 cm(-1) around 30.5 T for both samples. This splitting is due to a three-level resonance between the second LI, of the first electron subband and the lowest LL of the second subband plus an LO phonon. The large splitting in the presence: of high electron densities is due to the absence of occupation (Pauli-principle) effects in the final states and weak screening for this three-level process. (C) 2000 Published by Elsevier Science B.V. All rights reserved

High-field cyclotron resonance and electron-phonon interaction in modulation-doped multiple quantum well structures

A systematic study of electron cyclotron resonance (CR) in two sets of GaAs/Al0.3Ga0.7As modulation-doped quantum-well samples (well widths between 12 and 24 nm) has been carried out in magnetic fields up to 30 T. Polaron CR is the dominant transition in the region of GaAs optical phonons for the set of lightly doped samples, and the results are in good agreement with calculations that include the interaction with interface optical phonons. The results from the heavily doped set are markedly different. At low magnetic fields (below the GaAs reststrahlen region), all three samples exhibit almost identical CR which shows little effect of the polaron interaction due to screening and Pauli-principle effects. Above the GaAs LO-phonon region (B > similar to 23 T), the three samples behave very differently. For the most lightly doped sample (3 x 10(11) cm(-2)) only one transition minimum is observed, which can be explained as screened polaron CR. A sample of intermediate density (6 x 10(11) cm(-2)) shows two lines above 23 T; the higher frequency branch is indistinguishable from the positions of the single line of the low density sample. For the most heavily, doped sample (1.2 x 10(12) cm(-2)) there is no evidence of high frequency resonance, and the strong, single line observed is indistinguishable from the lower branch observed from sample with intermediate doping density. We suggest that the low frequency branch in our experiment is a magnetoplasmon resonance red-shifted by disorder, and the upper branch is single-particle-like screened polaron CR. (C) 1998 Elsevier Science B.V. All rights reserved

Resonant magnetopolaron effects in GaAs/AlGaAs multiple quantum well structures

A detailed experimental study of electron cyclotron resonance (CR) has been carried out at 4.2 K in three modulation-doped GaAs/Al0.3Ga0.7As multiple quantum well samples in fields up to 30 T. A strong avoided-level-crossing splitting of the CR energies due to resonant magnetopolaron effects is observed for all samples near the GaAs reststrahlen region. Resonant splittings in the region of AlAs-like interface phonon modes of the barriers are observed in two samples with narrower well width and smaller doping concentration. The interaction between electrons and the AlAs interface optical phonon modes has been calculated for our specific sample structures in the framework of the memory-function formalism. The calculated results are in good agreement with the experimental results, which confirms our assignment of the observed splitting near the AlAs-like phonon region is due to the resonant magnetopolaron interaction of electrons in the wells with AlAs-like interface phonons. (C) 1998 Elsevier Science B.V. All rights reserved