Government healthcare spending and maternal mortality
Economics—questions rather than answers J Thorp University of North Carolina Center for Women’s Health Research, Chapel Hill, NC, USA Linked article: This is a mini commentary on M Maruthappu et al., pp. 1216–1224 in this issue. To view this article visit http://dx.doi.org/10.1111/1471-0528.13205. Published Online 23 January 2015. As clinicians, we focus on individuals and try to take evidence from clinical trials and observational studies and apply it to their scenarios. Some of us function as epidemiologists and try to improve the health of whole populations. Few of our readers, including this commentator, will have the expertise to assess health economic models like those used in this paper, other than to appreciate how complex the task is to find meaningful relationships. Maruthappu et al. bring their expertise to economic data from the European Union and find a relationship between decreases in gov-
ernment healthcare expenditures and maternal mortality. Clinicians who deliver babies will realise that maternal deaths are rare in the developed world and usually reflect the culmination of an array of individual and population-based phenomena that have gone awry. The economist authors speculate that the relationship may be mediated by the presence of skilled birth attendants. Practitioners would retort that almost all births in the European Union are attended by a physician or midwife and if that were the weakened link in the chain why would it not persist for longer than 1 year? Moreover, in a paradox
© 2015 Royal College of Obstetricians and Gynaecologists
of progress, it is the most affluent who often choose not to deliver at a hospital or birth centre. This is not written to dismiss economic conclusions but to alert our reader to the complexity inherent in economic modelling. We clinicians cannot do the economic calculations but we do care for mothers and babies and can bring our experience and wisdom to the conversations. Clinicians need economists and vice versa. We must work together to inform public policy.
Disclosure of interests Nothing to disclose. &
1225
Economics—questions rather than answers J Thorp University of North Carolina Center for Women’s Health Research, Chapel Hill, NC, USA Linked article: This is a mini commentary on M Maruthappu et al., pp. 1216–1224 in this issue. To view this article visit http://dx.doi.org/10.1111/1471-0528.13205. Published Online 23 January 2015. As clinicians, we focus on individuals and try to take evidence from clinical trials and observational studies and apply it to their scenarios. Some of us function as epidemiologists and try to improve the health of whole populations. Few of our readers, including this commentator, will have the expertise to assess health economic models like those used in this paper, other than to appreciate how complex the task is to find meaningful relationships. Maruthappu et al. bring their expertise to economic data from the European Union and find a relationship between decreases in gov-
ernment healthcare expenditures and maternal mortality. Clinicians who deliver babies will realise that maternal deaths are rare in the developed world and usually reflect the culmination of an array of individual and population-based phenomena that have gone awry. The economist authors speculate that the relationship may be mediated by the presence of skilled birth attendants. Practitioners would retort that almost all births in the European Union are attended by a physician or midwife and if that were the weakened link in the chain why would it not persist for longer than 1 year? Moreover, in a paradox
© 2015 Royal College of Obstetricians and Gynaecologists
of progress, it is the most affluent who often choose not to deliver at a hospital or birth centre. This is not written to dismiss economic conclusions but to alert our reader to the complexity inherent in economic modelling. We clinicians cannot do the economic calculations but we do care for mothers and babies and can bring our experience and wisdom to the conversations. Clinicians need economists and vice versa. We must work together to inform public policy.
Disclosure of interests Nothing to disclose. &
1225
