The midwifery model estimator - a business costing tool for scaling-up midwifery continuity of care in health and hospital services in Queensland, Australia

Abstract

Background: Expansion of cost-effective Midwifery Continuity of Care (MCoC) is a priority for women in Australia and a key feature of government policy. To scale-up MCoC hospitals and health services require costing and decision-making tools.

Objectives: To showcase the Midwifery Model Estimator, a custom - built interactive costing tool. The Estimator was developed for Queensland Health as a component of the Midwifery Continuity of Care Costing Toolkit (2020). The tool supports development of robust business cases for service re-design. This enables scale up of MCoC.

Methods: The Estimator uses National Hospital Data Collection and Queensland - wide averages to estimate costs. Included are costs associated with any in-patient health-service use in Queensland public hospitals (labour through to 1 year postpartum for mother and child). Relative risk calculation for each intervention and resource use was calculated. Women who received MCoC were compared to all others.

Results: Cost benefit relative to proportion of women receiving MCoC is achievable. Local data can be used to show potential cost saving through different scenarios of MCoC in hospitals of differing size / classification. Provider value for each intervention avoided and funder value associated with different activity was shown for: caesarean section, induction, epidural, episiotomy, NICU and Special care nursery admission, and vaginal birth.

Conclusions: This cost tool supports preparation of business cases for scaling up MCoC. Expanding MCoC addresses the triple aim of improving the experience of care, improving the health of populations, and reduces per capita costs of health care.

Key message: The Midwifery Model Estimator supports scaling-up MCoC. The tool has broad application and can be used in other countries.

Keywords: Midwife led care Policy Midwifery workforce