BackgroundAgeing populations, more expensive technology, growing rates of chronic disease and increasing consumer expectations are expected to lead to increased demand for health services and a rise in health expenditure within Australia. Productivity and efficiency analysis of Australia’s health system could provide valuable insight into the performance of the health system and assist stakeholders to reduce unnecessary growth in public hospital expenditure. This review describes efficiency and productivity analyses of hospitals in Australia, Canada and the United Kingdom. Methods We conducted a systematic literature review of efficiency and productivity analyses of hospitals in Australia, Canada and the United Kingdom. The search was conducted in two stages; (1) a search of the grey literature using a Google search engine; and (2) a traditional systematic review method search of academic databases. It is uncommon for grey literature to have abstracts, therefore, executive summaries, table of contents or subheadings were screened. Titles and Abstracts of journal articles were screened. DiscussionWithin Australia and key comparator nations, the number of efficiency and analysis studies is small. There is no clear consensus on the most suitable analysis technique to measure efficiency and productivity of hospitals. However, selection of inputs is similar across all studies identified in this review, consisting of measures of labour (most commonly relating to full time equivalent employees), goods and services (e.g. purchased consumables, such as drugs), and capital. Similarly, the majority of studies struggled to identify output measures that could capture improvements in patient outcomes, a key performance measure for any hospital. Instead, most studies utilised proxy measures relating to hospital throughputs (number of separations) or population health measurements. Of note, only one study demonstrated active engagement with the health sector in study development. Conclusion There is considerable scope for the further development of efficiency and productivity analysis techniques that can adequately capture relevant production factors, allow for robust comparisons across hospitals and time periods and which meaningfully engage with the health sector to inform improvements in efficiency and productivity.

Background In maternity services, as in other areas of healthcare, increasing emphasis is placed on improving “efficiency” or “productivity”. The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult. The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care. Methods This paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia’s national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services. Results There are significant gaps in Australia’s maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure. Conclusions Adoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia’s national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care.

Objective To describe change in costs to different funders over time for women giving birth in Queensland between 2012 and 2018. Methods A whole-of-population linked administrative dataset was used that contained all health service use in Queensland for women who gave birth between 1 July 2012 and 30 June 2018 and their babies. Aggregated costs for mother and baby from pregnancy to 12 months postpartum were used to compare the change in costs to funders over time. Results There was an increase in mean total cost to all funders per birth in the public system and private system from 2012 to 2018. North West Hospital and Health Service (HHS) had the highest mean total cost (in Australian dollars) in 2018 (A$42 353), while home births had the lowest (A$6105). For the majority of HHSs the proportion of births with a positive birth outcome (as defined by a composite outcome measure) has remained largely static or declined during this time period. Cairns and Hinterland HHS and Townsville HHS had the largest declines of 15% and 16% respectively, while mean total cost to all funders rose 36.39% and 46.41%, respectively. Conclusions There has been an increase over time across Queensland in the cost of childbirth in public hospitals and in the private system, while the cost of home birth has remained static. For most HHSs this increase in cost is also associated with little change or a decline in the percentage of births with a positive outcome. Increases in cost are therefore not being translated into better outcomes for women and their babies. Routine performance monitoring of cost, quality and safety should be adopted to ensure the provision of high value maternity care in Australia.

Background: In maternity services, as in other areas of healthcare, increasing emphasis is placed on improving “efficiency” or “productivity”. The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult. The aim of this paper is to identify potential output measures that reflect the principles of woman-centred care and that can be used in an assessment of the efficiency and productivity of maternity services in Australia. Methods: This paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia’s national maternity strategy; and based on this data, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services. Results: The identified composite measure consists of labour and birth outcomes indicators where data is available from the National Perinatal Data Collection. The composite measure makes it very clear that there are significant gaps in Australia’s maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access. Conclusions: Adoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia’s national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality.