Introduction: In Ontario, prior to 1994, planned home birth attended by midwives was a self-paid service. Since the introduction of regulated midwifery in 1994, home birth is a government-funded service, and uses common resources. As such, there is a need to examine the impact that choice of planned location of birth puts on scarce resources. To date, costs associated with planned place of birth in Ontario have not been evaluated.
Objectives: The primary objective is to answer the question: Do planned midwifery-attended home births from the onset of labour cost the Ontario health care system more or less than planned midwifery-attended hospital births from the onset of labour among a comparable low-risk cohort of women? Specifically, this analysis examines the cost of midwifery intrapartum care, from the onset of labour until hospital discharge or the first two days after delivery.
Methods: This cost-analysis used a third-party payer perspective (health services costs) to analyze data from the Ontario Midwifery Program, which included 12, 886 midwife-attended births that occurred between April 1, 2003 and March 31, 2006. Three main sources of information were used to determine unit cost and health care utilization: the Ontario Midwifery Program data (2003-2006); data from the Ontario Case Costing Initiative; and the 2010 Schedule of Benefits for Physician Services. Data was analyzed using an intention to treat approach, i.e. based on planned rather than actual location of delivery.
Results: Hospital birth is more expensive than planned home-birth. Results were significant with a P value =< .001. The median cost from the onset of labour was $995.95 (IQR $995.95 to $995.95) for planned home birth compared to $2118.12 (IQR $1467.12 to $3610.00) for planned hospital birth.
Conclusions: Home birth, a choice that women in Ontario will continue to choose, does not result in costing the Ontario health care system more money. / Thesis / Master of Science (MSc) / This thesis answers the question: Do midwifery-attended planned home births cost the Ontario health care system more or less than midwifery-attended planned hospital births? This thesis examined midwifery-attended births that occurred in Ontario between April 1, 2003 and March 31, 2006 and associated costs that were incurred for both the mother and the baby from the onset of labour until two days following the birth. Since 1994 when midwifery was legislated in Ontario, registered midwives have been providing care to women in both home and hospital settings. While there is general consensus within the midwifery community that home births do not cost the health care system more money, a thorough analysis of costs incurred by midwifery-attended births has not been meaningfully analyzed. Midwifery is the only group of health care professionals providing maternity care that is increasing in size. Given the shortage and the current crisis of maternity care providers, the number of midwives in this province is likely to continue growing. At the same time, a cost analysis of the resources consumed through the provision of maternity care – both at home and at hospital- has not been conducted. This study provides key stakeholders with information regarding resources used and needed and the costs associated with these resources so that resource allocation and planning can be conducted in a responsive manner.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/19706 |
| Date | January 2016 |
| Creators | Press, Elissa |
| Contributors | Hutton, Eileen, Gafni, Amiram, Beyene, Joseph, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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