Actuary breaks new ground in public health research

I often get asked what an actuary does in maternal health and public policy more broadly. Actuaries will quickly get the picture after a short conversation. However, for many outside the profession, this conversation is intriguing as they have less knowledge of the actuarial skill set and its applications outside of financial services. 

Considering a career change?

I started my actuarial career like many others – I worked in investment advisory and general insurance roles in Australia and the UK. My time in traditional roles in industry provided me with a great foundation to move into new areas. When my husband and I moved back home from London (when we were 6 months pregnant with our first baby) I took a career break from industry to spend more time with our growing family but also to think about what I wanted to do next.

‘Born Too Soon’

My own personal experiences with pregnancies and babies were far from easy and I noticed there were still lots of unanswered questions in the field. I was determined to find a way to contribute to the area but still use my actuarial skill set. So, I started doing some research and discovered a report called “Born Too Soon” by the World Health Organisation. This opened my eyes to the complexity of the problems associated with premature births and the need for more research in the area. The report planted the seeds for my PhD research, which has a special focus on women who experience adverse birth outcomes, such as premature births and stillbirths, which can be devastating for the women and families involved. I quickly found a great team of people who were very supportive of my interests and understood the strengths an actuarial mind could bring to some pressing questions. The PhD also proved to be a sanity saver for me during those years at home with my little treasures (pictured below)!

Using actuarial techniques in my PhD

In a nutshell, my PhD used traditional general insurance pricing principles to identify and quantify the risk factors of public maternal health system costs. I looked at government funded hospital costs and out-of-hospital costs of women during their perinatal periods which I defined as their pregnancies, delivery periods and the first year following the birth of their baby.

I used some amazing datasets too – in particular, I linked longitudinal survey data from the Australian Longitudinal Study for Women’s Health and various government administrative datasets such as Medicare Data, the Admitted Patients Data Collection and the Perinatal Data Collection together to provide in-depth information on health system costs and births. The use of these linked datasets gave me a comprehensive picture of women during their perinatal periods. This enabled a much more detailed and nuanced analysis of costs and their drivers than has ever been done before.

I used techniques such as Classification and Regression Trees and Generalised Linear Mixed Modelling to model the costs and tested hundreds of factors to identify the statistically significant cost risk factors. A major strength of this project was the diverse mix of skills in the team that was involved – we had experts from statistics, health economics, public policy, maternal health and psychology – which also helped me upskill in areas which were previously new to me.

Results and policy recommendations – data-driven public policy

There were lots of interesting results that we are now doing further research on. On the hospital side, it was not surprising that ‘mode of delivery’ was the most significant cost risk factor. Caesarean deliveries cost almost twice as much as vaginal deliveries. Other statistically significant cost risk factors were:

• private health insurance status;
• adverse birth outcomes;
• smoking status;
• pre-existing diabetes; and
• area of residence.

For the out-of-hospital study we found mental health factors (such as postnatal depression) were the most significant cost risk factors. We outlined policy recommendations to target this area including early intervention for mental health, which may reduce the cost burden over the life-course. As women are better equipped with coping strategies earlier in their lives, they can draw on these when they experience major life events – like the birth of a baby. We are planning to conduct a cost benefit analysis for these policy recommendations to provide more evidence for their viability.

Another major finding which we are continuing to investigate is the complex interactions between the public and private maternal health system and the implications this has for maternal health policy. It is the transformation of the evidence base into practical maternal health policy (or “data-driven public policy”) that is focused on improving the health outcomes of women (rather than just costs!) that I am most excited about and working on now.

Driving future social change

These days I still spend most of my time on data-driven public policy through my own consulting business and research with my job as a lecturer at the ANU. I still focus on non-traditional areas and have branched out into human services where the skills I gained during my PhD have been valuable. The team I work with now through the Social Outcomes Lab is focused on analytics both from a “top-down” big data perspective but also through working directly with client groups, from the ground-up, to drive meaningful social change for people who are most vulnerable in society.

One of our recent projects was on breaking the cycle of disadvantage which looked at finding indicators of “success” over the life-course of those who are most disadvantaged in society. Success was defined as something which can significantly change the trajectory of a person’s life – for example, finishing Year 12 was found to be an important predictor of whether an individual remains disadvantaged in the future. Our current project is a hot topic in the public domain as it explores interventions for family and domestic violence in faith-based communities and we are focusing on Muslim and Christian communities to start with. The project team is comprised of experts from many different fields which include public policy, law, psychology, theology, statistics and economics.

And I still get asked by actuaries and non-actuaries what an actuary can do in these areas!

Related articles and publication:

• “An actuarial investigation into maternal hospital cost risk factors for public patients”, Annals of Actuarial Science 
• ANU study reveals costs of maternal health
• Collaborative research into public health costs

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