Unpacking childbirth expenditures: what are the factors driving extreme costs in Serbia?

Maternity healthcare costs vary widely due to demographic, pregnancy-related, and clinical factors. Understanding the drivers of extreme costs is crucial for optimizing resource allocation and ensuring equitable access to quality maternal healthcare. This study aimed to identify factors associated with extreme hospital childbirth costs in a tertiary-level hospital in Belgrade, Serbia.

A cross-sectional study was conducted on 6,949 women who gave birth in 2019. Maternal age, parity, pregnancy characteristics, delivery method, anesthesia type, perinatal interventions, and comorbidities were analyzed. Costs were categorized as expected or extreme, and multivariate logistic regression identified significant predictors of extreme costs.

In our study, 4.1% of mothers required extreme-cost hospitalization and treatment, and these extreme costs were significantly more prevalent among older women, first-time mothers, preterm births, and pregnancies ending in cesarean section. Mothers with extreme costs had a median hospital stay of 23 days compared to 5 days for those with expected costs (p < 0.001). The median total cost of maternity healthcare was 604.3 USD. Women undergoing cesarean delivery had four times higher odds of incurring extreme costs compared to those with spontaneous vaginal delivery.

Identifying cost-driving factors in maternity healthcare can improve financial planning and resource distribution in tertiary healthcare settings. Strategies to reduce unnecessary interventions, improve prenatal risk assessment, and optimize hospital stays should be explored to balance cost efficiency with high-quality maternal healthcare.