Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

Xu, Xiao; Lee, Henry; Lin, Haiqun; Lundsberg, Lisbet S.; Pettker, Christian M.; Lipkind, Heather S.; Illuzzi, Jessica L.

doi:10.1111/1471-0528.15007

Cited by 13 publications

(13 citation statements)

References 48 publications

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“…According to the administrative region of the country, OOP was highest for the Dhaka division, as Dhaka is the capital of Bangladesh and the living cost was higher than those of other regions in the country. The study showed that the richest wealth quintile spent significantly more than poorest quintile, although higher cost does not always guarantee the better birth outcome . However, it was well reported that the wealthiest households always used more maternal care services than those in the poorest households, in the Bangladeshi context .…”

Section: Discussionmentioning

confidence: 96%

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

Sarker

Sultana

Ali

et al. 2018

Health Planning & Management

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The study showed that there was a huge variation of OOP, which was dependent on the facility and socioeconomic demographic status of the households. As such, policy efforts need to focus on lowest wealth quintiles to avoid economic burdens during child delivery-related activities, and therefore, financial risk protection should be provided. Social health insurance might be an option for financing during child delivery, which is in line with the core objective of the Healthcare Financing Strategy of Bangladesh, which is to achieve universal health coverage.

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Section: Discussionmentioning

confidence: 96%

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

Sarker

Sultana

Ali

et al. 2018

Health Planning & Management

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“…25 Examples included maternal age, parity, fetal presentation, gestational age, hypertensive disorders of pregnancy, adequacy of prenatal care, and whether mother was transferred-in. 25 Examples included maternal age, parity, fetal presentation, gestational age, hypertensive disorders of pregnancy, adequacy of prenatal care, and whether mother was transferred-in.…”

Section: Patient Risk Factorsmentioning

confidence: 99%

“…25 Examples included maternal age, parity, fetal presentation, gestational age, hypertensive disorders of pregnancy, adequacy of prenatal care, and whether mother was transferred-in. 25 They were measured using birth certificate data elements, as well as diagnosis codes and admission source documented on hospital discharge records.…”

Section: Patient Risk Factorsmentioning

confidence: 99%

“…As hospitals might differ in patient case mix which could confound their performance, we measured a comprehensive set of clinical risk factors reflecting maternal comorbid conditions and obstetric/fetal indications that might influence birth outcomes. 25 Examples included maternal age, parity, fetal presentation, gestational age, hypertensive disorders of pregnancy, adequacy of prenatal care, and whether mother was transferred-in. See Table S1, Supporting Information for a complete list of these risk factors.…”

Section: Patient Risk Factorsmentioning

confidence: 99%

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Optimal maternal and neonatal outcomes and associated hospital characteristics

Campbell

Illuzzi

Lee

et al. 2018

Birth

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Background: This study aims to examine hospital variation in both maternal and neonatal morbidities and identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. Methods: Using the California Linked Birth File containing data from birth certificate and hospital discharge records, we identified 1 322 713 term births delivered at 248 hospitals during 2010-2012. For each hospital, a risk-standardized rate of severe maternal morbidities and a risk-standardized rate of severe newborn morbidities were calculated after adjusting for patient clinical risk factors. Hospitals were ranked based on combined information on their maternal and newborn morbidity rates. Results: Risk-standardized severe maternal and severe newborn morbidity rates varied substantially across hospitals (10th to 90th percentile range = 67.5-148.2 and 141.8-508.0 per 10 000 term births, respectively), although there was no significant association between the two (P = 0.15). Government hospitals (non-Federal) were more likely than other hospitals to be in worse rank quartiles (P value for trend = 0.004), whereas larger volume was associated with better rank among hospitals in the first three quartiles (P = 0.004). The most prevalent morbidities that differed progressively across hospital rank quartiles were severe hemorrhage, disseminated intravascular coagulation, and heart failure during procedure/surgery for mothers, and severe infection, respiratory complication, and shock/resuscitation for neonates. Conclusions: Hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance. Hospitals with smaller volume and government ownership tend to have less desirable outcomes and warrant additional attention in future quality improvement efforts. K E Y W O R D Schildbirth, hospital variation, morbidity, obstetric, quality and safety 290 | CAMPBELL Et AL.

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“…Meanwhile, prior studies have reported wide variability in the provision of maternal care, leading to uctuations in overall childbirth costs (3)(4)(5). This phenomenon has generated substantial interest, with researchers particularly focusing on facility-related characteristics and their impact on cost variability (6)(7)(8). However, the available literature offers less information about the factors driving cost variation within hospitals.…”

Section: Introductionmentioning

confidence: 99%

A Time-Driven Activity-Based Costing Approach for Identifying Variability in Costs of Childbirth Between and within Types of Delivery

Dubron

Verschaeve

Roodhooft

2021

Preprint

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Background Recently, time-driven activity-based costing (TDABC) is put forward as an alternative, more accurate costing method to calculate the cost of a medical treatment because it allows the assignment of costs directly to patients. The objective of this paper is to demonstrate how the overall cost of childbirth at the maternity department can be calculated by implementing a TDABC analysis. In addition, this study outlines how this costing method can be utilized to provide insights into how patient and disease characteristics drive variability within childbirth cost. Through the use of process mapping, TDABC allows to exactly identify which activities and corresponding resources are impacted by these characteristics, leading to a more detailed understanding of childbirth cost.Methods Process maps were developed for two types of childbirth, vaginal delivery (VD) and caesarean section (CS). Costs were obtained from the financial department and capacity cost rates were calculated accordingly. Results Overall, the cost of childbirth equals €1894,12 and is mainly driven by personnel costs (89,0%). Monitoring after birth is the most expensive activity on the pathway, costing €1149,70. Significant cost variations between type of delivery were found, with VD costing €1808,66 compared to €2463,98 for a CS. Prolonged clinical visit (+33,3 min) and monitoring (+775,2 min) in CS were the main contributors to this cost difference. Within each delivery type, age, parity, number of gestation weeks and education attainment were found to drive cost variations. In particular, for VD an age >25 years, nulliparous, gestation weeks > 40 weeks and higher education attainment were associated with higher costs. Similar results were found within CS for age, parity and number of gestation weeks.Conclusions TDABC is a valuable approach to measure and understand the variability in costs of childbirth and its associated drivers over the full care cycle. Accordingly, these findings can inform health care providers, managers and regulators on process improvements and cost containment initiatives.

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Hospital variation in cost of childbirth and contributing factors: a cross‐sectional study

Abstract: Hospitals vary in cost of childbirth. Institutional characteristics significantly contribute to the variation.

Cited by 13 publications

References 48 publications

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

Cost comparison and determinants of out‐of‐pocket payments on child delivery care in Bangladesh

Optimal maternal and neonatal outcomes and associated hospital characteristics

A Time-Driven Activity-Based Costing Approach for Identifying Variability in Costs of Childbirth Between and within Types of Delivery

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