A cost-analysis of midwife-attended home births compared to midwife-attended hospital births in Ontario

Abstract

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.