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Hi
I hate to spoil the fun but it is not possible
to compare the costs of homebirth and hospitals. They are two different models
- it's like comparing the costs of apples and cherries. Perhaps some whiz
bang economists such as the ones from access economics could do it.
I don't think we should go down this path. It is
the quality of the models and the outcomes long and short term that we should be
looking at not costs. Anyway there seems to very little difference.
What 'they' save on hospitalisation is usually spent on the labour
associated with the close one to one relationship midwives and women
develop. If we talk too much about comparable costs some bright spark will
assume the models are the same only one is midwife and one doctor led. If that
happens we are in real danger of being accused of over servicing ie some
community midwives offer women 10 (may be more) antenatal consults lasting over
an hour when the average doc gives about five of 20 minutes each!! Yet, the
birth outcomes are similar. A doctor is only present for the birth and we
are often there for 24 hours! Is that overservicing? Yeah I know the docs have
hospital midwives but these people are in the place anyway so don't cost any
more. When early discharge came in we all thought that hospital costs would drop
- they didn't cause they used the beds for other things. Birth centres and
homebirth projects account for about 5% of births but hospitals haven't reduced
the number of docs or midwives in the main hospitals or the beds. In fact even
though hospital births have decreased by say 5% hospital costs have
increased!
I don't think the funding people have the
ability or desire to think outside the square yet. Anyway they don't care that
midwife-led models gives women a real sense of satisfaction not to mention an
experience that is orchestrated by her or that breast feeding rates and duration
are longer. What drives funding bodies is things like APGAR scores,
technologies and mortality rates not what women and their families think
about birthing or the benefit of full breast feeding for twelve months on child
and adolescent health. You can't cost these!
Carol
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