Problem: 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.
Background: 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.
Aim: 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.
Methods: 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.
Findings: 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.
Discussion: Consistent with existing literature, continuity of care by independently practicing midwives was less costly in NZ after adjustment for demographic and clinical differences.
Conclusions: Funding structures and population pregnancy risk profile are important considerations in the implementation of midwifery-led continuity of care models.
Statement of significance: Problem: Health systems seek to improve maternity care and contain healthcare budgets.
What is already known: 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.
What this paper adds: 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.
Keywords: Caesarean section, New Zealand; Continuity of care; Cost analysis; Midwife.
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