An actuarial investigation into maternal hospital cost risk factors for public patients

We investigate an actuarial approach to identifying the factors impacting government-funded maternal hospital costs in Australia, with a focus on women who experience adverse birth outcomes. We propose a two-phase modelling methodology that adopts actuarial methods from typical insurance claim cost modelling and extends to other statistical techniques to account for the large volume of covariates available for modelling. Specifically, Classification and Regression Trees and generalised linear mixed models are employed to analyse a data set that links longitudinal survey and administrative data from a large sample of women. The results show that adverse births are a statistically significant risk factor affecting maternal hospital costs in the antenatal and delivery periods. Other significant cost risk factors in the delivery period include mode of delivery, private health insurance status, diabetes, smoking status, area of residence and onset of labour. We demonstrate the efficacy of using actuarial techniques in non-traditional areas and highlight how the results can be used to inform public policy.