The Irish government has pledged to improve maternal choice by expanding midwifery-led care throughout the country. Earlier this year, I posted about an Irish study examining women’s preferences for maternity care and subsequent motivations when choosing place of birth (Maternity Care – what do women want?). Since then, the cost-benefit analysis of midwifery- and consultant-led care in Ireland has been published in Applied Health Economics & Health Policy.
This is the first study to estimate the net benefit of consultant- and midwifery-led models of care using cost-benefit methodology and women’s preferences for maternity care, with the results arriving at a particularly useful juncture in Irish policy formulation. While both models of care are cost-beneficial for low-risk patients, the net benefit for consultant led-care is considerably smaller. This study demonstrates the demand for midwifery-led care in Ireland, which is currently provided in only two hospitals in the north-east of the country. It also demonstrates potential cost-savings from providing midwifery-led care for low-risk women as an alternative to consultant-led care in hospitals across Ireland. It is important to note that consultant-led care is necessary for high-risk patients and is an important maternal choice for all maternity care patients.
This research was supported by the National Perinatal Epidemiology Centre of Ireland.
A colleague has pointed out this Economist piece on gambling to me. Check out the figures on average annual gambling losses per resident adult, and where Ireland comes in the list: am I the only one who thinks these numbers are enormous? Or that we should perhaps be worried about them — especially the very large online component?
(This also gives me an excuse to complain about the FAI’s League of Ireland streaming deal with an online gambling company.)
In 2012, the Irish government outlined a strategic framework for reform of the health service. Ensuring patients are treated at the lowest level of complexity is a major tenet of this reform. Within the Irish health care system, maternity care remains heavily medicalised. Depending on obstetric risk, maternity care may be provided in one of two locations at hospital level: a consultant-led unit (CLU) or a midwifery-led unit (MLU). Care in a MLU is sparsely provided in Ireland, comprising as few as two units out of a total 21 maternity units. Given its potential for greater efficiencies of care and cost-savings for the state, there has been an increased interest to expand MLUs in Ireland. Yet, very little is known about women’s preferences for midwifery-led care, and whether they would utilise this service when presented with the choice of delivering in a CLU or MLU.
A recent study sought to involve women in the future planning of maternity care by investigating their preferences for care and subsequent motivations when choosing place of birth. It is the first qualitative study to explore women’s preferences for alternative models of maternity care in Ireland. Overall, the results suggest that women may prefer MLUs when co-located with existing CLUs. While safety concerns largely influenced women’s preferences, the results also suggest that women do not have a clear preference for either model of care, but rather a hybrid model of care which encompasses features of both consultant and midwifery-led care. This suggests that the DOMINO (Domiciliary Care In and Out of Hospital) scheme may be preferred by maternity users as it closely resembles the preferences revealed in this study.
The full paper has recently been published in Health Policy and can be accessed here. This study precedes a broader, quantitative exploration of demand for alternative models of maternity care. The results of which will inform policymakers on whether an expansion of midwifery-led care reflects demand and value for money.
I would like to acknowledge all my co-authors on this paper, in particular, Dr. Christopher Fawsitt who undertook this work as part of PhD dissertation, and Prof. Richard Greene, the clinical lead on this project. This research was supported by the National Perinatal Epidemiology Centre of Ireland.
Last month, as the UK called time on the EU, the Health Research Board (HRB) released a sobering report on the harm and cost of alcohol consumption in Ireland. Using data from the hospital in-patient reporting system, the authors examine the patterns and effects of alcohol consumption and the impact on Irish society.
The report is extensive and thorough, with headline figures, such as:
- In 2014 Irish drinkers consumed on average 11 litres of pure alcohol, with 50% of drinkers consuming alcohol in a harmful manner. Among 36 OECD countries, Ireland has the fourth highest alcohol consumption.
- The number of people discharged from hospital whose condition was totally attributable to alcohol rose by 82% between 1995 and 2013. Three people died each day in 2013 as a result of drinking alcohol and in 2014 one-in-three self-harm presentations were alcohol-related.
- In 2013, alcohol-related discharges accounted for 160,211 bed days in public hospitals – 3.6% of all bed days that year. €1.5 billion is the cost to the tax-payer for alcohol-related discharges from hospital. That is equal to €1 for every €10 spent on public health in 2012 (This excludes the cost of emergency cases, GP visits, psychiatric admissions and alcohol treatment services).The estimated cost of alcohol-related absenteeism was €41,290,805 in 2013.
The full report is here, with a summary of findings in graphical form here.