Excess NHS costs – Spend money on public health interventions not excess health care services

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By Kelly Morgan

Obesity is a permanent item on the news agenda for the foreseeable future, with rising rates amongst adults and children alike. Pregnancy is no exception: one in 20 women in the UK attending antenatal clinics are ‘severely obese’ (defined by the Centre for Child and Maternal Enquiries as having a body mass index of at least 35 kg/m2).

In order for a health improvement intervention to be supported by funders and public health specialists, it needs to be cost-effective. At Swansea University, we carried out a study to estimate the amount of money which could be spent on public health initiatives to reduce weight gain in women before pregnancy, and still save money overall, due to reduced use of health services during pregnancy. We examined the use of health services, and associated costs, among healthy weight and overweight/obese pregnant women.
Who was involved? 
Women for our research were recruited face-to-face at antenatal clinics throughout Swansea and Neath Port Talbot. All had participated in the Growing Up in Wales: Environments for Healthy Living birth cohort (EHL). All women aged 16 years and over receiving antenatal care through the Abertawe Bro Morgannwg University NHS Trust were eligible to participate in the EHL study.   

After agreeing to take part in our study, each participant was visited at home by researchers. Here, each participant was asked to complete a questionnaire and diet diary, their antenatal records were accessed, and measures of size and body composition (such as weight, height, mid-arm circumference and skinfold measures) were collected. Full information concerning the study protocol can be found in the study protocol.   

Later we accessed participants’ General Practice (GP) and hospital admission records through Swansea University’s Secure Anonymised Information Linkage (SAIL) databank. Records were used to establish the participants’ use of health services throughout the course of pregnancy and two months after delivery. We looked at: 

  • The number of GP visits; 
  • What medication had been prescribed by a GP;
  • The number of inpatient admissions and their duration;
  • The number of outpatient visits.    

The cost of each GP visit, inpatient and outpatient admission (with a specific cost for each specialty), and each prescribed medication were obtained from documented price lists. Costs were then added up for each participant over the 11 month period. We directly compared the costs of treating healthy weight, overweight and obese women. Costs related to the infant were not considered. 

What were the results?
In comparison to women with a ‘healthy’ BMI (defined by the World Health Organisation as a value between 18.5 and 24.9 kg/m2), we found: 

1)      Higher usage of hospital services and accompanying direct healthcare costs in overweight and obese women;

2)      Overweight women showed a 23% increase in total health service costs (an extra £698 per overweight woman);

3)      Obese women showed a 37% increase in total health service costs (an extra £1172 per obese woman).

Given these extra costs, it would be cost-effective to increase spending on public health interventions aiming to help overweight and obese women to lose weight before pregnancy. Of equal importance, this would also benefit the long-term health of the mother and the newborn.

What next? 
In an era of financial strain, it is vital that we manage NHS Wales healthcare budgets effectively. Our findings demonstrate the amount of money that is currently being spent on provision of services/treatment related to overweight and obesity in pregnancy. Importantly, our findings are not intended to victimise women. Our research shows policy makers and public health specialists that this money could be more efficiently spent on interventions to prevent overweight and obesity in women of child-bearing ages.



Kelly Morgan is a Research Assistant at Swansea University, and is currently undertaking a DECIPHer-affiliated PhD entitled ‘Risk factors for cardiovascular disease and diabetes in pregnancy and the health of the infant at age 12 months’. She tweets at @_KellyMorgan_.

This piece describes research undertaken as part of Kelly’s PhD, and summarises the following paper:

Morgan K, Rahman M, Macey S, Atkinson M, Hill R, Khanom A, Paranjothy S, Husain M, Brophy S. ‘Obesity in pregnancy: a retrospective prevalence-based study on health service utilisation and costs on the NHS’ BMJ Open 2014;4:e003983. doi:10.1136/bmjopen-2013-003983.

Photo source: TipsTimesAdmin

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