Preventing Low Birthweight (1985) / Chapter Skim
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10. Prenatal Care and Low Birthweight: Effects on Health Care Expenditures
10. Prenatal Care and Low Birthweight: Effects on Health Care Expenditures
Pages 212-238
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From page 212... ...
Formal cost-benefit and cost-effectiveness analyses, including estimates of the present value of low birthweight infants, were not feasible, however, because of problems in the quality and uniformity of available cost data, uncertainties about the life expectancy of low birthweight infants with significant morbidity, difficulties in delineating the services received, and uncertainties about target populations. Within the domain of prenatal care costs, the committee elected to undertake a narrow set of tasks.
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From page 213... ...
Although prescription of a particular set of prenatal services to produce a defined reduction in low birthweight is not possible at this tome, the estimates of a reduced rate of low birthweight used in this analysis appear achievable. This judgment is based in part on studies reviewed in Chapter 6 that, despite qualifications, demonstrate reductions in low birthweight associated with adequate prenatal care, and in part on the multivariate analysis presented in Chapter 3, which indicates that a significant reduction in low birthweight rates could result from changes in the timing and frequency of prenatal visits.
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From page 214... ...
The cost of low birthweight reflects initial expenditures on intensive care; rehospitalization costs of survivors dur ing the f irst year and a single-year estimate of the annual long-term medical expenses of those who survive the first year of life and do not require ~nstitutional~zation. The cumulative direct long-term medical expenses of both institutionalized and noninstitutionalized survivors are excluded, as are the indirect costs of lost productivity from infants who survive with handicaps and from the family members who care for them.
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From page 215... ...
Moreover, because women receiving public assistance al so are likely to receive public subsidy for medical care, both the outlays for additional prenatal care and the savings from a reduced incidence of low birthweight involve governmental funds. In computing the number of births among the target group, the committee used age- and race-specif ice, but not education-specif ic, natal ity rates .
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From page 216... ...
That is, the supply of resources for provision of care would be sufficiently elastic to meet the increased demand. Total Cost of Prenatal Care The committee examined national vital statistics data on the timing of prenatal care in relation to race and educational statuses For a TABLE 10.1 Total Cost Computations = unit cost of prenatal care = unit cost of initial hospitalization of low-weight infant C3 = unit rehospitalization cost of surviving low-weight infant C4 = unit long-term, single year morbidity cost of surviving low-weight infant TC1 = total additional cost of prenatal care = C1 x (P13 + °.5P12)
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From page 217... ...
In the estimate of the initial hospitalization cost=, the committee included an unknown number of infants (probably of moderately low birthweight) who would not have required or received intensive care in Level II or III neonatal intensive care units.
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From page 218... ...
For example, if all live births were shifted to the normal weight category, there would still be some expected costs due to hospitalization, rehospitalization, and long-term morbidity. Alternatively, no adjustment has been made for cost savings in infant care associated with the improved health of normal birthweight infants born to pregnant women who have received improved prenatal management.
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From page 219... ...
However, even if additional prenatal care costs were substantially greater, the committee's conclusions would still be valid. Fifth, this analysis does not take into consideration the possible costs of appropriate medical interventions during the prenatal period that might not have occurred without the increased provision of prenatal services to these high-risk pregnant women.
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From page 220... ...
Description of Costs This section summarizes the costs reported in the literature for the provision of prenatal and delivery services to pregnant women, of neonatal intensive care to low birthweight infants, of subsequent postneonatal hospitalization to surviving infants, and of long-term medical care to survivors. It also presents and justifies the estimates used by the committee for each cost component in the analysis.
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From page 221... ...
. Initial Hospitalization Costs Reported costs and charges for the initial hospitalization of low birthweight infants in intensive care units vary enormously, from only
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From page 222... ...
In an analysis of the cost of providing health services to low birthweight infants and low-income pregnant women, the Michigan Depar tment of Health r epor ted that the average approximate cost of neonatal intensive care was $20,000, with an average length of stay of 17 to 27 days; it was not indicated whether scheme were reimbursed costs or charge=.~° Pomerance et al. reported an average cost of $62,730 for the hospital component of neonatal intensive care provided to low birthweight infants born at less than 35 weeks of gestation.
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From page 223... ...
The American Hospital Association reported $372 as the average cost of an inpatient hospital day.3~ This figure is used in our cost comparison analysis. It underestimates the true cost of car ing for rehospitalized low birthweight infants because their care on general pediatric wards requires the utilization of substantially more personnel services and other expensive resources than that of the average patient, and because many of these infants are admitted to intensive care units .
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From page 224... ...
Results of the Cost Comparison In th is section, the committee presents the results of its cost comparison. The cost of providing additional prenatal care to the target population is compared with the potential reduction in singles year medical care costs of low birthweight infants that would result from a decrease in ache low birthweight rate (following the increased use of prenatal care)
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From page 225... ...
Births to Women on Public Assistance by Age and Race, 1979 15-17 18-19 20-24 25-29 30-34 35-39 Total Live Bar thsa Black 7 ,189 13,790 43 ,043 28,893 12,730 3,709 109,354 White 3,441 9,478 51,778 51,570 23,777 5,751 145,795 Total 10,630 23,268 94,821 80,463 36,507 9,460 255,149 LBW Birt~hsb Black 1,046 1,849 5,628 3,730 1,658 501 14,412 White 273 661 3 ,375 3 ,222 1,428 395 9,354 Total 1,319 2,510 9,003 6,952 3,086 896 23,766 aData from analysis of 1980 Census Public Use, Microdata Sample, prom vided by Northern Ohio Data and Information Service. Cleveland, Ohio, Spr ing 1984 .
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From page 226... ...
TABLE 10.3 Total Live Births and Low Birthweight (LBW) Births to Women on Publ ic Ass istance Who Completed Less Than 12 Year s of School by Age and Race 15-17 18-19 20-24 25-29 30-34 35-39 Total Live Bir that Black 6 ,416 6 ,935 17 ,308 12,677 5 ,866 2 ,221 51,423 White 2 ,176 4 ,954 20 ,953 19 ,138 9,136 2,821 59 ,178 Total 8,592 11,889 38,261 31,815 15,002 5,042 110,601 LBW B~rthsb Black 955 1,026 2 ,797 1,882 871 329 7,860 Mite 244 415 1,739 1,534 682 245 4,859 Total 1,199 1,441 4,536 3,416 1,553 574 ~ 2,719 aData from analysis of 1980 Census Public Use, Microdata Sample, prom vided by Northern Ohio Data and Information Service.
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From page 227... ...
A potential weakness of this computation is that the pattern of initiation of prenatal care services for women receiving public assistance may be different from the national pattern that has been assumed, because a greater proportion may be receiving late or no prenatal care or "nonadequate" care, as discussed in chapters 3 and 7. In addition, this cost estimate does not take into consideration the number of women at high risk of delivering a low birthweight infant who may enter prenatal care early.
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From page 228... ...
Initial Hospitalization Cost Savings The 12,719 low birthweight infants (P2 in Figure 10.1) born to the target population are assumed to require Level II or III neonatal intensive care dur ing the per iod of initial hospitalization.
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From page 229... ...
These considerations may explain, in part, why many of the cost estimates for neonatal intensive care found in more recent studies are higher than those of Budetti. Finally, the trend toward a reduction in the number of term low birthweight infants (Chapter 3)
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From page 230... ...
An 8 percent mortality rate was used to estimate the number of low Birthweight infants who would not survive the neonatal period.33 42 Estimated total costs (TC3 in Table 10.1) for rehospitalization of the 2 ,449 low Birthweight infants (at a low Birthweight rate of 11.5 percent)
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From page 231... ...
Thus, in using an estimated cost saving for only 1 year, the committee has substantially understated the cost savings for noninstitutional ambulatory direct medical care of low birthweight children in the calculation of net cost savings.39 40 These estimates assume that low birthweight infants with long-term morbidity are comparable in their resource utilization to other groups of chronically ill children. Although there are some data suggesting that the proportion of very low birthweight infants with disabilities decreases with age, and expenditures for institutionalization may be changing because of deinstitutionalization policies, adequate information is not available to make a more discriminating analysis at this time.
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From page 232... ...
At a low birthweight rate of 10.76 percent, the savings In low birthweight infant care costs would equal the additional costs of prenatal care services. Finally, although the committee ' s calculations and examples focus only on governmental fiscal outlays for a selected Group of women receiving public assistance, there are, of course, many more women at high risk of bearing a low birthweight infant.
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From page 233... ...
Rates Reduction in Outlays for Total LBW Cost of LBW Additional Net Cost Infant Costs Infant Care Prenatal Care Savings LaW Rate (TC5)
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From page 234... ...
11. Malitz D: Cost benefit analysis of extending Texas Medicaid coverage to provide prenatal care to pregnant women.
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From page 235... ...
14. Committee to Study the Prevention of Low Birthweight: The role of Medicaid in delivering prenatal care to low income women.
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From page 236... ...
3 9. The cost savings are the reduced expenditures for initial hospitalization of fewer low birthweight infants at the 10 percent and 9 percent low birthweight rates, respectively.
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From page 237... ...
~ [$8,000 x 10,9001~. This would not affect the validity of the committee's basic conclusion that there would be a net cost saving from additional prenatal care services if the low birthweight rate were reduced to 9 percent.
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