Preterm Birth Causes, Consequences, and Prevention (2007) / Chapter Skim
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14 Public Policies Affected by Preterm Birth
14 Public Policies Affected by Preterm Birth
Pages 455-472
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From page 455... ...
, Title V Maternal and Child Health Programs, fos ter care programs, and the juvenile justice system. Little is known about the magnitude of the public burden, aside from the costs associated with medical expenditures for preterm birth paid for by Medicaid.
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From page 456... ...
The second aspect is the potential for public policy to be used to reduce the rate of preterm birth and improve the health outcomes for infants born preterm. For instance, a recommendation from the 1985 Institute of Medicine report Preventing Low Birthweight (IOM, 1985)
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It is not possible, however, to assign the dollar amounts associated with preterm birth to each of these programs because of a lack of available data. For many programs, no information on the number of beneficiaries who were born with low birth weights is available.
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458 PRETERM BIRTH TABLE 14-1 Selected Public Programs Affected by Preterm Birth Income State Options Total Budgetary Expenses, Program Eligibility for Eligibility Fiscal Year 2004 ✓ ✓ Health insurance $471 billion Medicaid ✓ ✓ State Children's Health $11.2 billion Insurance Program ✓ Supplemental $36.4 million Security Income ✓ Education (early $11.1 million intervention and special education services) ✓ ✓ Temporary Assistance $19.6 million to Needy Families ✓ Title V Maternal $730 million and Child Health Programs Other Foster care $6.8 million Juvenile justice $336 thousand SOURCES: ACF (2005)
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From page 459... ...
Congress considered whether it should include the same benefits package available through Medicaid but ultimately decided to require a less generous package for status, choosing to develop a new program, SCHIP, rather than simply expanding the state Medicaid programs. Thus, although SCHIP covers increasing numbers of children in households with incomes above the Medicaid eligibility levels, SCHIP may not offer many longterm-care services.
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From page 460... ...
Early intervention and special education services may therefore greatly aid children and youth with chronic conditions, but they also account for substantial public expenditures. Supplemental Security Income The SSI program provides cash assistance to low-income people with substantial disabilities.
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Although it is not known how many individuals enrolled in the SSI programs for adults and children were born preterm, preterm birth and its possible adverse long-term health outcomes generate public costs through the SSI program. These public costs can extend far into the future for any child born preterm, potentially for the entire life course.
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. The remaining 15 percent of the federal funds support a variety of special programs of regional and national significance in maternal and child health.
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Finding 14-1: The distribution of the costs of preterm birth be tween the public and the private sectors and among constituencies within these sectors has not been determined. Children born preterm may require a wide array of publicly supported services.
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The lack of data that can be used to inform policies has been reported elsewhere. In 2001, the Advisory Committee on Infant Mortality published a report that reviewed the current literature and concluded that the findings from the literature justified "considerable investment in research programs, and policies focused on the goal of decreasing the incidence of preterm delivery, and thus of low birth weight and infant mortality" (ACIM, 2001, p.
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From page 465... ...
associated with Medicaid eligibility expansions without a coincident shift in earlier care. 3Preterm birth prevention programs have a variety of features, including early and frequent visits, weekly or biweekly cervical ultrasounds, case management, and education regarding the warning signs of preterm labor.
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From page 466... ...
However, women who had a preterm birth are at risk for a recurrence in a subsequent pregnancy (Adams et al., 2000; Iams et al., 1998; Krymko et al., 2004) , possibly because many of the biobehavioral risk factors for preterm birth are carried from one pregnancy to the next.
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Better measures of the quality of health care therefore need to be developed to enable the implementation of quality improvement efforts and to guide public policy. The organization of the health care delivery system has long been viewed as a key determinant of birth outcomes.
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From page 468... ...
. Evidence-based hospital referral standards for infants born with very low birth weights required that infants who had an expected birth weight of less than 1,500 grams, a gestational age of less than 32 weeks, or correctable major birth defects be delivered at a regional NICU with an average daily census of 15 or more.
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Nonetheless, the rate of mortality among infants born preterm could decline dramatically by focusing policies on improving the quality of hospital care. A recent study demonstrated that for the Vermont Oxford Network, if all hospitals achieved risk-adjusted mortality rates of the highest performing quintile, the overall mortality rate for very low birth weight infants would decrease by 24 percent (Rogowski et al., 2004b)
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From page 470... ...
It has been difficult to replicate these results in other countires. As discussed in Chapter 1, it is difficult to draw comparisons of preterm birth rates among various countries because of differences in measurement of gestational age, reporting of fetal deaths and live births which affect preterm birth rates, and variations in maternal characteristics and behaviors, social environment, and health services.
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From page 471... ...
Beyond segregation, there is some evidence that racism and discrimination have also been associated with poorer pregnancy outcomes. Public policies affecting housing, segregation, discrimination, and the built environment may hold promise for reducing the rate of preterm birth and reducing the disparities in the rates of preterm birth by race and ethnicity.
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From page 472... ...
However, further evidence needs to be developed before specific recommendations related to environmental exposures can be made. Finding 14-3: Effective public policies that will reduce the rates of preterm birth and improve the outcomes for infants born preterm will require a better understanding of the determinants of preterm birth and the determinants of healthy outcomes for infants born preterm and better information on effective interventions.
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