Medicalised childbirth: variation in care and drivers of maternal health service provision in Queensland, Australia

Haylee Fox examined the patterns of maternal health care and service provision among the Australian population. She found that inequitable maternal health care and service provision exists between population groups, which is not solely attributable to clinical need. These results are being used in 'normal birth' guidelines in Queensland

Cost of preterm birth to Australian mothers: Assessing the financial impact of a birth outcome with an increasing prevalence

Aim: To examine the differences in return to work time after childbirth; the differences in income; and the differences in out of pocket health-care costs between mothers who had a preterm birth and mothers who delivered a full term baby in Australia. Methods: Using administrative data, the length of time and 'risk' of returning to employment for mothers whose child was born premature relative to those whose child was born full term was reported. Multivariate linear regression models were constructed to assess the difference in maternal income and the differences in mean out-of-pocket costs between mothers who had a preterm birth and mothers who had a full term birth. Results: The mean length of time for mothers of babies born full term to return to work was 1.9 years and for mothers of preterm babies it was 2.8 years. Mothers of preterm babies had a significantly lower median income ah at 0-1, 2-3 and 4-5 years postpartum compared to mothers of full term babies. The adjusted mean out of pocket costs for health care paid by mothers who had a preterm birth was $1298 for those whose child was aged 32-36 weeks; and$2491 for those whose child was aged <32 weeks. This is in comparison to mothers of children born 37 weeks and over, whose mean out of pocket costs were $1059. Conclusion: Mothers who have a preterm birth have longer return to work time, a lower weekly income and also have higher out of pocket costs compared with mothers who have a full term birth

What are the costs associated with child and maternal health care within Australia? A study protocol for the use of data linkage to identify health service use, and health system and patient costs

Introduction: The current literature in Australia demonstrates that there are variations in access and outcomes in perinatal care based on socioeconomic factors. However, little has been done looking at the level of out-of-pocket healthcare costs associated with perinatal care. The primary aim of this project will be to quantify health service use and out-of-pocket healthcare expenditure associated with childbearing and early childhood in Queensland, Australia. Methods and analysis: This project will build Australia's first model (called Maternal & Child Cost MOD) of out-of-pocket healthcare expenditure by using administrative data from the Queensland Perinatal Data Collection, of all childbearing women and their resultant children, who gave birth in Queensland between 1 July 2012 and 30 June 2016. The current costs to the health system and out-of-pocket health care expenditure of patients associated with maternity and early childhood health care will be identified. The differences in costs based on indigenous identification, socioeconomic status and geographic location will be assessed using linear regression modelling and counterfactual modelling techniques. Ethics and dissemination: Human Research Ethics approval has been obtained from Townsville Hospital and Health Service Human Research Ethics Committee (HREC) (HREC Reference number: HREC/16/QTHS/223). Consent will not be sought from participants whose de-identified data will be used in this study. Permission to waive consent has been gained from Queensland Health under the Public Health Act 2005.The results of this study will be disseminated through publications in peer-reviewed journals and through presentations at conferences, regionally and nationally. Our target audience is clinicians, health professionals and health policy-makers

Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system

Background: Poor health increases the likelihood of experiencing poverty by reducing a person's ability to work and imparting costs associated with receiving medical treatment. Universal health care is a means of protecting against the impoverishing impact of high healthcare costs. This study aims to document the recent trends in the amount paid by Australian households out-of-pocket for healthcare, identify any inequalities in the distribution of this expenditure, and to describe the impact that healthcare costs have on household living standards in a high-income country with a long established universal health care system. We undertook this analysis using a longitudinal, nationally representative dataset - the Household Income and Labour Dynamics in Australia Survey, using data collected annually from 2006 to 2014. Out of pocket payments covered those paid to health practitioners, for medication and in private health insurance premiums; catastrophic expenditure was defined as spending 10% or more of household income on healthcare. Results: Average total household expenditure on healthcare items remained relatively stable between 2006 and 2014 after adjusting for inflation, changing from $3133 to$3199. However, after adjusting for age, self-reported health status, and year, those in the lowest income group (decile one) had 15 times the odds (95% CI, 11.7-20.8) of having catastrophic health expenditure compared to those in the highest income group (decile ten). The percentage of people in income decile 2 and 3 who had catastrophic health expenditure also increased from 13% to 19% and 7% to 13% respectively. Conclusions: Ongoing monitoring of out of pocket healthcare expenditure is an essential part of assessing health system performance, even in countries with universal health care

Evidence of overuse? Patterns of obstetric interventions during labour and birth among Australian mothers

Background: There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric intervention is more prevalent among wealthier mothers with no medical need of it. In Australia, the rates of caesarean section and other obstetric interventions are rising. These rising rates of intervention have been mirrored by a decreasing rate of unassisted non-instrumental vaginal deliveries. In the context of rising global concern about rising caesarean section rates and the known health effects of caesarean section on mothers and children, we aim to better characterise the use of obstetric intervention in the state of Queensland, Australia by examining the characteristics of mothers receiving obstetric intervention. Identifying whether there is overuse of obstetric interventions within a population is critical to improving the quality, value and appropriateness of maternity care. Methods: The association between demographic characteristics (at birth) and birth delivery type were compared with chi-square. The percentage of mothers based on their socioeconomic characteristics were reported and differences in percentages of obstetric interventions were compared. Multivariate analysis was undertaken using multiple logistic regression to assess the likelihood of receiving obstetric intervention and having a vaginal (non-instrumental) delivery after accounting for key clinical characteristics. Results: Indigenous mothers, mothers in major cities and mothers in the wealthiest quintile all had higher percentages of all obstetric interventions and had the lowest percentages of unassisted (non-instrumental) vaginal births. These differences remained even after adjusting for other key sociodemographic and clinical characteristics. Conclusions: Differences in obstetric practice exist between economic, ethnic and geographical groups of mothers that are not attributable to medical or lifestyle risk factors. These differences may reflect health system, organisational and structural conditions and therefore, a better understanding of the non-clinical factors that influence the supply and demand of obstetric interventions is required

A review of the impact of financing mechanisms on maternal health care in Australia

Background: The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. Methods: We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia’s maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications’ full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. Results: A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. Conclusion: Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia’s maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance – typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great

Population trends and potential policy drivers of the medicalisation of birth.

The rising rates of obstetric interventions (1-3) have been identified as an issue in Australian maternal healthcare reform for over a decade (4-6). This concern is due to the increasing rates of morbidity and mortality (7-13) and the higher costs associated with caesarean section compared to vaginal birth (14)

North Queensland Primary Health Network performance framework: baseline assessment and benchmarking package

This document provides a series of recommendations regarding the implementation of annual performance assessment by the NQPHN. It compiles the surveys that can be utilised, or sources of data that can be extracted, to undertake annual baseline and benchmarking results of population health, patient experience, provider experience and cost. Where sources of data already exist, it details the baseline performance of the NQPHN for the 2016/17 financial year, as well as setting out the external benchmarking data that the NQPHN can compare its performance against

North Queensland Primary Health Network performance framework: baseline assessment and benchmarking package

This document provides a series of recommendations regarding the implementation of annual performance assessment by the NQPHN. It compiles the surveys that can be utilised, or sources of data that can be extracted, to undertake annual baseline and benchmarking results of population health, patient experience, provider experience and cost. Where sources of data already exist, it details the baseline performance of the NQPHN for the 2016/17 financial year, as well as setting out the external benchmarking data that the NQPHN can compare its performance against

Health service use and health system costs associated with diabetes during pregnancy in Australia

Background and aims: In the context of the rising rate of diabetes in pregnancy in Australia, this study aims to examine the health service and resource use associated with diabetes during pregnancy. Methods and results: This project utilised a linked administrative dataset containing health and cost data for all mothers who gave birth in Queensland, Australia between 2012 and 2015 (n = 186,789, plus their babies, n = 189,909). The association between maternal characteristics and diabetes status were compared with chi-square analyses. Multiple logistic regression produced the odds ratio of having different outcomes for women who had diabetes compared to women who did not. A two-sample t-test compared the mean number of health services accessed. Generalised linear regression produced the mean costs associated with health service use. Mothers who had diabetes during pregnancy were more likely to have their labour induced at <38 weeks gestation (OR:1.39, 95% CI:1.29-1.50); have a cesarean section (OR: 1.26, 95% CI:1.22 -1.31); have a preterm birth (OR:1.24, 95%: 1.18-1.32); have their baby admitted to a Special Care Nursery (OR: 2.34, 95% CI:2.26-2.43) and a Neonatal Intensive Care Unit (OR:1.25, 95%CI: 1.14-1.37). On average, mothers with diabetes access health services on more occasions during pregnancy (54.4) compared to mothers without (50.5). Total government expenditure on mothers with diabetes over the first 1000 days of the perinatal journey was significantly higher than in mothers without diabetes ($12,757 and$11,332). Conclusion: Overall, mothers that have diabetes in pregnancy require greater health care and resource use than mothers without diabetes in pregnancy