Delivering continuity of midwifery care to Queensland women

Section 7
Costing and revenue for caseload models
Evidence demonstrates caseload models of care cost less than
traditional models of maternity care. This is due to:
• flexible care delivery which is responsive to demand
• increase in spontaneous labour rates with decreases in obstetric
interventions and associated reductions in costs
• decreased length of stay so decreased demand on bed occupancy
• decreased readmission rates
• increased staff satisfaction in caseload with improved retention of workforce (Collins, et
al. 2010; McCourt & Page 1996; Sandall 1997; Sandall 1998).
Midwives working for Queensland Health in a caseload model will be paid an annualised
salary in recognition of flexible patterns of work to provide continuity of care. The annualised
salary is the ordinary rate of pay and an all purpose loading (of 35 per cent at time of
publication), which is in compensation for ordinary hours worked and in consideration of
all other penalty rates and allowances the midwife would have been entitled to under the
Award if not working within the caseload arrangement. No backfilling is required in normal
circumstances (e.g. annual leave).
Section 8 of this guide provides information about industrial issues and awards in continuity
of care models.
Establishment costs
Many of the current midwifery models have been established by realigning resources and
reconfiguring work patterns from traditional models with little or no additional cost (for
detailed examples see the Goondiwindi Midwifery Group Practice First 12 Month Review
available from the NMOQ website; and chapter six of Midwifery Continuity of Care by Homer,
et al. 2008). Other models have invested additional resources to set up continuity models
to serve expanding birth numbers. Some areas have channelled funding for the universal
postnatal contact service to continuity models rather than add an additional component to
the traditional fragmented service.
Staff costs can be re-oriented without additional costs to the District over current service
provisions.
In 2006 the Mater Mothers’ Hospital introduced an MGP for young mothers in an all risk
model based on a caseload of 35 women annually per midwife. Savings of $577 were
identified for each woman accessing this care, and used to offset costs for equipment
(K. Wilson, personal communication, March 23, 2011).
Local overhead costs should be reviewed as these vary between services and have been
reported to sometimes be overinflated. Where birth centres exist, this space should be
reviewed in line with Queensland Health Service Planning Benchmarks (Queensland Health
2010b)and ensure capacity is maintained at 160 births per birth centre room per annum to
optimise cost savings.
Input costs
The input costs listed below (Table 1) for setting up an MGP are based on six FTE midwives
providing care to 240 women per year (note that this is the maximum caseload). The
definitions and detail of caseload and MGP are discussed in Section 2 and the glossary of
this document.
A guide to implementation
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