More babies die in larger Australian public hospitals

Babies born in large city hospitals are more likely to die in their first month than those born in smaller rural centres, a comprehensive analysis of Australian births has revealed. The findings have prompted experts to call for a "complete rethink" of maternity service planning across the country. The researchers for the study, which was reported yesterday in an international journal, say the findings prove smaller centres are safe - and undermine fears about quality that have led state governments to close scores of small maternity units nationwide in the past decade.

Study co-author Sally Tracy, a senior research fellow at the National Perinatal Statistics Unit at the University of NSW, said that over the past 10 years "at least half" of the smaller rural maternity units across the country had been closed on safety grounds. "Big does not necessarily mean better ... it is time for a complete rethink about maternity service planning," she said. The study found 98.5per cent of 146,422 "multiparous", or non-firstborn, babies born in large hospitals were alive after 28 days, compared with 99.2per cent in very small units.

But Dr Tracy said while this was an expected result - because very high-risk or complicated cases would naturally be referred to the biggest hospitals - the real point was that death rates were no higher in smaller units. "All women do not need the very intense medical care that's available in these large tertiary hospitals," Dr Tracy told The Australian. "At this point, the policy in Australia is just to keep on closing these small units, and leaving rural women stranded to give birth on the side of the road." Rural doctors have also backed the findings.

For the study, published online by the British Journal of Obstetrics and Gynaecology, Dr Tracy and colleagues examined data from more than 702,000 women who gave birth from January 1, 1999, to December 31, 2001 - representing more than 90per cent of all births in that time. The researchers grouped hospitals into five bands, based on how many babies they delivered each year. They also looked at the risk status of the mother, what interventions she required - such as epidurals and emergency caesarean sections - and whether the baby was alive after 28 days.

Among firstborns, 98.9per cent of the 4483 born in small units with fewer than 100 births annually were alive after 28 days, compared with 98.4per cent of the 115,940 born in the largest hospitals. Looking only at births considered low-risk - a more meaningful comparison - smaller units also saw slightly lower death rates, but because of the low numbers involved in the small units the difference was not statistically significant. As expected, higher levels of interventions were also recorded in bigger hospitals.

Queensland GP Ross Maxwell, president of the Rural Doctors Association of Australia, said the findings showed "low-risk delivery in small hospitals is very safe". "In rural Australia, we certainly need a strong rethink and more work to maximise the current workforce," he said.

Christine Tippett, vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said the findings had to be interpreted with caution and did not support the claim small units were safer for low-risk women.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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