Caseload Midwifery Care in Low-risk Pregnant Women in the Netherlands: A Budget Impact Analysis

Structured Abstract Problem Evidence on the budget impact of caseload midwifery is lacking. Background Caseload midwifery is associated with favourable pregnancy outcomes but is more resource intensive than standard midwifery. Aim To quantify the budget impact of implementing caseload midwifery as an alternative to standard midwifery care for low-risk pregnant women, based on both reimbursed and actual costs of care. Methods Estimates of reimbursed costs, referral rates, and mode of birth for both care models, and the number of care units and time spent on client-related tasks for standard midwifery care were derived from existing publications. Data on care units and time spent on client-related tasks among caseload-working midwives were collected from a survey among 33 caseload midwives. Findings The total reimbursed costs for midwife- and hospital services for low-risk pregnant women were estimated at €3644 per client in caseload midwifery and €4404 per client in standard midwifery care (17% saving). Because caseload midwives spend twice as much time per client compared to the standard care model, they care for fewer clients and therefore receive lower annual reimbursement. If the additional time spent on care would be reimbursed, caseload midwifery would be €5632 per client; 28% more expensive than standard midwifery care. Discussion and conclusion Caseload midwifery is associated with lower total reimbursed costs compared to standard midwifery care. However, due to the additional time spent per client by the midwife, its actual costs are higher. Further research is needed into cost-effectiveness and feasibility of caseload midwifery.