Case Synopsis

Dr. Philip Singe, the Medical Officer of Health at the King Public Health Unit, is in a meeting with Praveen Gill, manager of the Healthy Babies, Healthy Children (HBHC) program, and Vanessa Thomas, the director of the Family Health portfolio. The group is discussing options for delivering postpartum screening services under the provincially funded HBHC program. While program costs have increased steadily, funding from the provincial Ministry responsible for oversight of HBHC has been stagnant. The group must decide whether or not to cut costs by reducing the number of staff responsible for screening. Faced with the challenge of maintaining the effectiveness of screening services, the group weighs each option. Using expert opinion and historical information, the team must forecast costs and consequences to compare options systematically. The case includes worksheets for budgeting and cost-consequence analysis. Instructors can obtain a copy of the answer key from the MPH Program Office.

Case Objectives

  1. Understand the financial challenges posed by inflationary pressures and stagnant funding.
  2. Use cost-consequence analysis to articulate the trade-offs between a more intensive and a less intensive program.
  3. Develop a budget and identify opportunity costs that are not reflected in the budget.
  4. Informed by historical data and expert opinion, forecast health consequences and resource use.
  5. Perform a cost-consequence analysis from the perspective of the public health unit.
  6. Conduct a sensitivity analysis, varying key input parameters in order to appraise the effect of uncertainty on analysis results.

Case Study Questions

  1. Should the public health unit continue hospital-based postpartum screening at the same level of intensity?
  2. Are there additional factors that are not referenced in the case that may influence this decision?
  3. How would the hospital sector be influenced if the public health unit reduced the number of staff in the hospital?
  4. What additional cost items would be incorporated in the analysis if it were conducted from the perspective of the Province of Ontario?
  5. Is there a threshold level of effectiveness, below which it would be unethical to remove resources from the postpartum screening program?
  6. Using a cost-effectiveness plane, plot the cost savings and the reduction in the number correctly identified at risk.


economic evaluation, cost-effectiveness analysis, cost-consequence analysis, decision analysis, maternal and child health, public health unit

Additional Author Information

Ava John-Baptiste, PhD, Assistant Professor

Yoshith Perera, MD, MPH

Sudit Ranade MD, MPH, MBA, CCFP, FRCPC, Medical Officer of Health, County of Lambton



Recommended Citation

John-Baptiste, A., Perera, Y., Ranade, S. (2016). Babies and Budgets: Balancing Costs and Consequences in Postpartum Screening. in: Terry, A.L. & John-Baptiste, A. [eds] Western Public Health Casebook 2016. London, ON: Public Health Casebook Publishing.