Reorientation of the Austrian parent-child preventive care programme

Research areas: Prevention and screening, Health economics

Marisa Warmuth, Philipp Mad, Ines Schumacher
Duration: April 2010 - March 2011

Additional project contribution: Stefan Mathis, Tarquin Mittermayr, Imke Schall, Tina Loibl
Suggested by: Austrian Ministry of Health (BMG)
Language: German

Publications: Reorientation of the Austrian parent-child preventive care programme.
Part I: Epidemiology - Frequency of risk factors and disease during pregnancy and early childhood.
HTA Project Report 045a 
Part II: International policies, concepts and screening strategies focusing on “normal” and “high-risk” development processes during pregnancy and early childhood until school entry.
HTA Project Report 045b
Part III: Financing structures of services and public transfers for parents and young children.
HTA Project Report 045c
Part IV: Synthesis of parts I-III, recommendations.
HTA Project Report 045d

Background
The mother-child-pass examination programme was launched in Austria in 1974. Since then, the spectrum of examinations has been steadily extended and the number of examinations has continuously increased. However, to date, neither the programme itself nor recently emerging needs have been systematically evaluated. An evaluation of the Austrian mother-child-pass examination programme primarily aims at analysing the specific needs of the target population in terms of width and depth of both existing services and new/ different services required as well as challenging the evidence-base of existing examinations in a second step.

The mother-child-pass examination programme is a classical (epidemiological) screening programme among healthy individuals. However, WHO criteria for screening should be applied. Currently, the mother-child-pass examination programme comprises of examinations of both the pregnant mother from the point of detection of pregnancy until delivery and the child from birth up to the 62nd month of life. The current mother-child-pass is predominantly “medicine-focussed” and more or less excludes diagnostic procedures/ care provided by other health professionals than doctors, such as midwives, nurses, physiotherapists, psychologists, social workers, besides others. However, this contrasts with more recent regional / national and international screening models targeting primarily risk populations (e.g. socially deprived women and children, women and children with a migration background etc.) that have special needs related to mother-child health care services.

Programme services have mainly been publicly financed by several public payers. Additionally, different incentive systems have been introduced to increase uptake of services. In order to establish a system of care that meets current needs, not least adequate financing structures are required.

Aim of the overall project
The aim is the development of a decision support document for the re-orientation of the mother-child prevention programme in Austria. It aims at easing the re-organisation process for stakeholders in order to adjust the prevention programme to the actual needs of the respective target population. 

Objectives

Part 1: Epidemiology and assessment of risk-factors as well as diseases
A synthesis and analysis of epidemiological data concerning existing risk factors and diseases in defined target-groups aims at highlighting the spectrum of risk factors and diseases, including their frequency. It should provide the basis for the assessment of services required.

Part 2: International instruments and “models of good practice” of mother-child health care services
The second part will cover a comparative analysis focussing on similar screening-instruments in the international context – on the one hand, this shall involve experiences relating to particular services provided for risk populations as well as other innovative services aspects for mother-child health, on the other hand.

Part 3: Economic analysis
Part three will describe the financing structures (payers, monetary flows, transfer of services), the inherent incentives as well as costs and expenditure of current services (mother-child-pass examinations and other preventive measures for pregnant women, newborns and children).

Part 4: synthesis of parts 1-3, recommendations for actions
Based on the results of parts 1-3 we aim at assessing the actual needs in terms of services required.

Research questions and methods

Part 1: Epidemiology and assessment of risk-factors as well as diseases

Which risk factors/diseases occur in the respective target group, how often do they occur?Which risk-factors occur in the respective target group at the individual level (age, sex, hereditary factors, life-style factors) and at the environmental level (social networks, working and living conditions, socioeconomic, cultural, and environmental factors)? How often do they occur and in which severity?Are there differences in risk-factors/ diseases in the respective target group depending on sociodemographic parameters, such as age, educational level, socioeconomic status, ethnic background, etc.?

Content

Pregnancy	risk factors and diseases of the mother	risk factors and diseases of the unborn child
Birth	risk factors and diseases of the mother	risk factors and diseases of the newborn
Babyhood and early childhood	risk factors and diseases of the baby/ child
Accompanying factors	life-style and psychosocial factors

Methods

• Systematic literature search in the following databases:  CRD-INAHTA, Embase, Ovid Medline, PsycINFO, PSYNDEX, The Cochrane Library, Web of Science und MedPilot
• Hand search in databases, selected medical journals, committees of professional societies, HTA-institutions
• Synthesis of statistical data from Austria (Statistik Austria, birth registry, health reports) concerning diseases/ risk-factors/ risky behaviour
• Comparison of assessed statistical data with the current mother-child-pass examination programme concerning examinations/ missing examinations/ lacking data
• Workshop with national experts

Part 2: International instruments and “models of good practice” of mother-child health care services

Which medical and psycho-social parameters are examined alongside mother-child examinations? Which time intervals are usually provided for mother-child examinations?Which professional groups (e.g. medical doctors, nurses, midwives etc.) are involved and at which stages of the overall examination process?Are there any country-specific mother-child health care aspects that inform about the service range as well as the service depth (i.e. services for special groups such as women experiencing domestic violence etc.)?

Methods

• Internet search on public sector information
• Systematic literature search and hand search in databases
• Questionnaire
• Comparative analysis of international screening-instruments and services
• Workshop with national experts

Part 3: Economic analysis

What are the financing structures (payers, monetary flows, service recipients) of the current maternity and child care programmes, what is the legal basis and how are they integrated in the overall health and social system?What are the incentives and what is the impact from the incentives (e.g. uptake of services) from the different systems historically? Are there international best practice models with respect to financing and incentive systems?What are the financing structures (payers, monetary flows, service recipients) of preventive services (in-kind or monetary) for pregnant women, newborns and children “beyond” the current maternity and child care programme?What are the costs for single services and what have been total public (and private) expenditures for maternity and child care programmes?

Methods

• Evaluation of public documents on financing structures and legal frameworks
• Interviews of payer representatives to gain additional information
• Analysis of costs and expenditure based on administrative data ( e.g. from social security funds and hospitals, ministry) and on secondary literature

Part 4: Synthesis of parts 1-3, recommendations for action

Which of the identified risks are adequately detected by the current maternity and child care programme?Are these risks also internationally considered in routine prevention (or prevention policy)? Which other, seemingly relevant, health risks are internationally alternatively/ additionally considered in maternity/ Child prevention programmes and for which target group? Are there any experiences, how these risks can be detected and which consequences of risk-population-prevention (strategy) could be observed? Which role does the financing of preventive measures (included/ not included in the current maternity/ child programme) take?

Methods

• Synthesis of results of parts 1-3
• Comparison of contents/ financial structure of the current maternity and child care programme with identified risks and international approaches