Could maternal ethnicity be a determinant of healthcare costs for birth assistance? Insights from a retrospective hospital-based study for the implementation of a woman-centered approach in obstetrics

Abstract

Background

Current policy and service provision recommend a woman-centered approach to maternity care and the development of personalized models for clinical assistance. Ethnicity has been recognized as a determinant in the risk calculation of selected obstetric complications. Based on these assumptions, our aims were to describe the linkage between baseline characteristics and maternal ethnicity and to analyze the cost for the local healthcare system, distinguishing mode of delivery, absence or presence of complications at birth, and maternal stay duration for all ethnic groups.

Methods

In a 5-year period (2012–16), all women admitted for delivery at the Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario “A Gemelli” IRCCS, Rome, Italy, were included in the analysis. Maternal demographics, adverse outcomes, and costs were evaluated. Economic calculations were performed by using the “diagnosis-related group” (DRG) approach.

Results

A total of 18,093 patients were included in the analysis. An overall care expense of €42,663,481 was calculated. Caucasian was the main ethnicity (90.7%), with 9.3% minority groups. Vaginal delivery (VD) was the most common mode of delivery in all ethnic groups, with a global rate of 59.6%. The highest cesarean section (CS) rates were observed among Maghreb (51.5%) and Afro-Caribbean (47.8%) women. Minority groups had a doubled rate of complicated VD, primarily Afro-Caribbean women (69.9%), followed by Asian (64.1%), Maghreb (63.2%), and Latin American (62.7%) women. Afro-Caribbean women had the highest rate of complicated CS compared to the overall study population (37.6 versus 28.5%, p < .005).

Conclusions

Minority groups have increased healthcare costs for birth assistance, mainly due to the higher rates of complications. In a prospective view, two strategies could be planned: first, calculating individualized risk to mitigate the clinical care charge, based on the ad hoc combination of ethnicity, mode of delivery, and obstetric complications; and second, endorsing the current financial return-on-investment opportunity tied to mitigating ethnic disparities in birth outcomes.

Keywords:

• Costs
• delivery
• cesarean section
• ethnicity
• maternal morbidity

Author contributions

Each author listed on the manuscript saw and approved the submission of this version of the manuscript and took full responsibility for the manuscript. There is not anyone else who fulfills the criteria that have been excluded as an author. Stefania Triunfo gave substantial contributions to the conception and design of the work. She was responsible for the analysis of data and their interpretation. She wrote the first draft of the work and approved the final revised version. Francesca Lofoco, Francesca Petrillo, and Massimo Volpe: were responsible for the acquisition of data, collaborated to their interpretation, revisited the work critically, and approved the final revised version. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Disclosure statement

No potential conflict of interest was reported by the authors.