About

The Fernandez Foundation has championed midwifery for over a decade, believing that midwife-led care for low-risk childbirth not only improves maternal and newborn outcomes but also reduces hospital costs. To rigorously test this hypothesis, the Max Institute of Healthcare Management at ISB, the Fernandez Foundation, and Leapfrog to Value (L2V) have launched a collaborative research project.

While the Fernandez Foundation's internal data suggests the benefits of midwifery, this research aims to provide a comparative analysis of the costs associated with midwifery versus the more commonly used obstetrician-led model. Although it might seem that midwifery would naturally incur lower costs due to reduced resource use, the situation is more intricate. Complexity arises from several factors:

• Midwives occasionally work in the obstetric unit, which can lead to shared space and resources.

• Midwives provide continuous care from active labor through post-delivery for a single patient, whereas obstetricians manage multiple patients with intermittent care.

• The midwife-led unit typically uses fewer medical resources compared to the obstetric unit.

Thus, this study aims to assess the costs to the hospital for operating both midwife-led and obstetrician-led units.

Methodology

A comprehensive time-driven activity-based costing (TDABC) methodology is employed to model the costs across the entire care pathway. The steps for conducting TDABC are as follows:

• Map the Process and Care Delivery Pathway: Identified three pathways: Midwife-led delivery, Obstetrician-led delivery, and Delivery led by an obstetrician with midwife assistance.

• Identify Key Resources by activity: Catalog clinical and non-clinical staff, medical and non-medical equipment, and space utilised in each activity of the care delivery pathway.

• Analyze Time Estimates: Estimate the time each resource spends on activities within each pathway.

• Estimate Resource Costs: Calculate the cost of each resource based on the time estimates.

• Aggregate Costs: Sum the total costs of all resources for each activity, then calculate the total cost for each pathway by combining the costs of all activities within that pathway.

Impact

This approach will deliver a comprehensive cost comparison between midwife-led and obstetrician-led deliveries, shedding light on the financial implications of each model. The cost model will also give insights into resource utilization and allocation, which can help the hospital form strategic operational decisions and optimize resource management.

Collaborators

Fernandez Foundation

Leapfrog to Value