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Obstetric care in the Netherlands: Manpower substitution and differential costs
Author(s) -
Butter Irene,
Lapre Ruud
Publication year - 1986
Publication title -
the international journal of health planning and management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.672
H-Index - 41
eISSN - 1099-1751
pISSN - 0749-6753
DOI - 10.1002/hpm.4740010203
Subject(s) - context (archaeology) , popularity , medicine , health care , differential (mechanical device) , maternity care , pregnancy , prenatal care , family medicine , demography , environmental health , population , psychology , geography , economic growth , economics , social psychology , archaeology , aerospace engineering , sociology , engineering , biology , genetics
Trends in the Netherlands show an expanded role for obstetricians in hospital‐based prenatal and natal care, as well as a shift in postnatal care away from hospitals to domiciliary care. While general practitioners attend a steadily declining share of total births, midwives continue to play a central role in supporting over 40 per cent of all births and in attending nearly two thirds of all home births, which, in the Netherlands, is the preferred option for more than a third of childbearing women. As shown in the figures, shifts of births into hospitals and of postnatal care out of hospitals produce opposite effects on obstetric expenditures. Cost differences are primarily associated with variation in location of care, and only secondarily with variation in provider of care, underscoring the importance of contrasting styles of obstetric management and their influence on costs. In the context of these observed transitions, the increasing popularity of policlinical deliveries constitutes a pivotal force whose impact to date appears to have been neglected by planners and health care decision makers.