Does supplementary prenatal nursing and home visitation reduce healthcare costs in the year after childbirth?
OBJECTIVE
This paper reports the costs of a programme of supplementary prenatal care, including healthcare costs, in the year following childbirth.


BACKGROUND
Publicly funded healthcare systems have provided pregnant women with adequate medical care, but access to resources to address their non-medical needs is still an issue. To improve women's access to pregnancy-related resources, a community-based, prenatal programme involving consultations with a specialist nurse, or nurse plus a home visitor was evaluated.


METHODS
A sample of 284 women who had participated in a randomized controlled trial of the prenatal care programme participated in this partial economic analysis. Women had been randomized to one of three trial arms: (1) standard care, (2) standard care plus consultations with a specialist prenatal care nurse, or (3) standard care plus nurse consultations and a home visitor. For the economic study, each woman was asked about her and her baby's use of healthcare services in the 12 months after the baby's birth. Health service utilization was multiplied by the unit cost of each service and summed to arrive at the total cost of services used. The study was undertaken in 2004.


RESULTS
Supplementary prenatal care neither increased the use of health services nor resulted in savings in health spending. Compared with standard care, women in the two intervention groups made more use of family physicians and less use of paediatricians, but no significant differences in the overall costs of health care were noted.


CONCLUSIONS
While supplementary prenatal care had no impact on costs, some benefits occurred for those at greatest risk of not accessing services. However, it would be premature to draw widespread recommendations for policy from the results of a single study. Further investment in prenatal care should continue to be accompanied by rigorous evaluation of its costs and the value that women place on the service provided.
Au
Flora
F
Centre for Health and Policy Studies, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. fau@ucalgary.ca
Shiell
Alan
A
van der Pol
Marjon
M
Johnston
David W
DW
Tough
Suzanne
S
D000328:Adult; D002170:Canada; D003152:Community Health Nursing / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009773:Obstetric Nursing / Q000191:economics*; D011247:Pregnancy; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data