Abstract
This study compared the cost-effectiveness of midwife services provided in birth centres operating as pilot projects with current hospital-based medical services in the province of Quebec. One thousand midwives’ clients were matched with 1,000 physicians’ clients on the basis of socio-demographic characteristics and obstetrical risk. Direct costs for the prenatal, intrapartum and postpartum periods were estimated. Effectiveness was assessed on the basis of three clinical indicators and four indices related to the individu-alization of care as assessed by women. Results show that the costs of midwife services were barely lower than or equal to those of physician services, but cost-effectiveness ratios were to the advantage of the midwife group, except for one clinical indicator (neonatal ventilation). Overall, this study provides rational support for the process of legalizing midwifery in the province.
Résumé
Cette étude a comparé le ratio coût/efficacité des services de sages-femmes offerts dans des maisons de naissance mises en place dans le cadre de projets pilotes et des services médicaux courants dispensés dans des hôpitaux au Québec. Mille clientes de sages-femmes ont été jumelées à 1 000 clientes de médecins sur la base de leurs caractéristiques sociodémographiques et de leur risque obstétrical. Les coûts directs encourus pendant les périodes prénatale, pernatale et postnatale ont été estimés. L’efficacité a été mesurée à l’aide de trois indicateurs cliniques et de quatre indices d’humanisation des soins tels que perçus par les femmes. Les résultats montrent que les coûts des services des sages-femmes sont à peine plus bas ou équivalents à ceux des services offerts par les médecins, mais les ratios coût-efficacité sont à l’avantage de l’option sage-femme, sauf pour un indicateur clinique (ventilation néonatale). Dans l’ensemble, cette étude apporte un appui rationnel au processus de légalisation de la pratique sage-femme au Québec.
Footnotes
One of four peer-reviewed papers in a paid insert to the Canadian Journal of Public Health.
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