104 4 CHAPTER 4 2022, 19, 1046 12 of 15 lack of time and finances were reasons to reverse changes in the organization of tasks and responsibilities in risk selection. Other studies into facilitators and barriers of collaboration between midwives and obstetricians also indicate a willingness to invest time as a facilitator of collaboration and a lack of finance as a barrier to collaboration and integrated care [45,46,51,52]. The current MNC payment system in The Netherlands may encourage professionals’ financial interest and reduce their willingness to invest time, which may influence decisions regarding MRS. The payment of midwives and obstetricians differs. Obstetricians working in university hospitals, and hospital-based midwives generally work as employees. Primary care midwives and obstetricians working in regional hospitals are generally self-employed and are paid on a fee-for-service basis. Some MCCs are experimenting with bundled payments. It remains unclear with payment system facilitates optimal MRS the most [53,54]. The results of this study call for an evidence- and value-based approach. The insights of this study into different MRS are necessary to further study the association between MRS and care outcomes. Systematic evaluations using randomized controlled trial or quasiexperimental designs are needed to study the association between MRS and outcomes. These evaluations should include effectiveness studies into allocation of resources, such as invested time and financial availability. Additionally, qualitative research is required to gain a better understanding of the association between professionals’ payment methods and decisions about MRS and the experiences of care professionals and women and different MRS. These studies can inform a high-value reform, achieving the best possible health outcomes with an optimal use of resources [8,55–57]. 5. Strengths and Limitations A strength of this study is that it is the first to explore the organization of tasks and responsibilities of primary care midwives and obstetricians in risk selection across The Netherlands. We used a questionnaire about the objective characteristics MRS to gain insight into the complexity of the organization of risk selection. The questionnaire was reviewed by many stakeholders and pilot-tested. We received responses from 69 out of the 71 MCCs in The Netherlands, meaning that almost all MCCs were represented in our sample. We received two or more responses in 94% of the MCCs, which provided us with multiple perspectives of the organization of tasks and responsibilities. However, a limitation of the study is that only representatives of the primary midwifery care practices and obstetrics departments were invited to fill in the questionnaire on behalf of their practice or department; they may not have represented the views and experiences of the whole practice or department. Additionally, in almost one-third of the MCCs, the participants’ responses of either the primary midwifery care practices or the obstetrics department were missing, which might have resulted in a partial view of the organization of tasks and responsibilities within a MCC [58,59]. 6. Conclusions In this study, we identified three MRS across regions in The Netherlands: (1) primary care midwives assess risk and initiating a consultation or transfer of care without discussing this first with the obstetrician, (2) primary care midwives assess the risk and make decisions about the consultation or transfer of care collaboratively with the obstetrician, and (3) models with other characteristics. Across these MRS, variations exist in several aspects, including the routine involvement of the obstetrician in the care of healthy pregnant women. We found no significant association between the MRS and levels of satisfaction. We recommend an evidence- and value-based approach in the pursuit of the optimal organization of risk selection. Further research is needed to analyze the associations between different MRS and maternal and perinatal outcomes, professional payment methods, resource allocation, and the experiences of women and care professionals.