Introduction The baby bonus, a cash payment introduced in 2004 by the Australian federal government to increase fertility, has attracted media attention and public debate over its merits.
An increase in births in Australia has been reported since 2004.1 In New South Wales (NSW), following the introduction of the baby bonus, there was an
increase in births to women having their third child or higher and the
reversal of a downward trend in births to teenagers.2 The impact of the baby bonus on birth rates has been evaluated, but not the subsequent effect on the healthcare system. Media reports have claimed that an increase in births has placed more pressure on maternity services3 and births have been shifted to local hospitals to reduce the pressure on tertiary hospitals.4
The aim of this study was to determine the impact of the baby bonus on the NSW health system, by measuring the increase in absolute numbers of patients utilising maternity and newborn services and the corresponding increase in costs.
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Results
From 1998 to 2008, 965 635 women delivered 981 178
infants in NSW. The number of women giving birth had a
gradually declining trend from 1998 to 2004, despite an
increase in births in 2000 (see Fig. 1). Following 2004, and
the introduction of the baby bonus, the number of births
increased to 89 140 in 2005 and continued to increase to
91 315 in 2006, 94 531 in 2007 and 94 864 in 2008. When comparing annual numbers of factors relating to
pregnancy and childbirth with the predicted numbers based
on the underlying trend,
three distinct patterns of trends
emerged, shown in Fig. 2.
The first trend pattern involves a declining trend from 1998
to 2004. From this trend, the numbers of births were
predicted to continue to decline; however, after 2004,
the observed numbers of births increased.
This trend was seen in the number of vaginal deliveries
(as shown in Fig. 2), instrumental deliveries, the number of
births in rural, urban and tertiary hospitals, the number of
infants admitted to a special care nursery or neonatal
intensive care unit and in the total number of infant
hospital days.
The second trend pattern shows an increasing trend
from 1998 to 2004, which was predicted to continue
to increase. The observed numbers also increased from
2005 to 2008, although at a steeper rate than predicted.
This trend was observed in the number of women receiving
regional analgesia or anaesthesia, the number of women who
sustained third-or fourth-degree perineal tears and the
number of multiple births and the number of preterm births.
The third trend pattern, as illustrated by the number of
births in private hospitals, has an increasing trend prior to
2004. The number of observed births continued to increase
from 2004; however, it was less than the predicted increase.
The number of emergency caesarean sections (those
performed after the onset of labour) and the number of elective
caesarean sections (those performed prior to the onset of
labour) also followed this trend.
The trend prior to the introduction of the baby bonus for
each variable is also illustrated in Table 1 as the average
annual percentage change from 1998 to 2004. For example
from 1998 to 2004, the number of births in tertiary hospitals
decreased an average of 1.1% per year. Table 1 also features
the absolute impact of the increase in births in 2008 on the
health system compared with pre baby bonus trends.
Compared with predicted estimates, in 2008, there was an
increase of over 11 000 singleton births, 8793 normal vaginal
deliveries, 2190 women receiving regional analgesia or
anaesthesia, over 1000 more preterm births each year and over
45 000 extra infant days in hospital. There were 4752 more
births than predicted from prior years’ trends in tertiary hospitals,
6105 in urban hospitals and 2964 in rural hospitals;
however, there were over 5000 less births in private hospitals
than predicted
.
Figure 3 shows the estimated costs of births in NSW from
1998 to 2008. From 1998 to 2004, the estimated cost of
births remained steady at just under $700 million, except for
2000 when costs increased to approximately $710 million.
The total cost of births in NSW in 2004, immediately prior
to the introduction of the baby bonus, was approximately
$700 million. This increased by $38 million in 2005 to
$738 million and increased another $60 to $798 million in
2008.