Academic journal article Health Care Financing Review

The Cost Effectiveness of Prenatal Care

Academic journal article Health Care Financing Review

The Cost Effectiveness of Prenatal Care

Article excerpt


During the past two decades, medical research has provided substantial evidence supporting the hypothesis that length of gestation and birth weight affect infant mortality and childhood morbidity (Gortmaker, 1979; Showstack, Budetti, and Minkler, 1984). Infants weighing less than 2,500 grams (or 5.5 pounds) have a mortality rate that is 40 times greater during the neonatal period than infants weighing more than 2,500 grams (McCormick, 1991). Not only do infants weighing less than 750 grams have lower survival rates, but they have an increased risk of serious neurologic and developmental impairment (Hack and Fanaroff, 1989).

Despite the importance of birth weight in birth outcome, the primary cause of perinatal mortality in the United States is preterm birth (Kleinman and Madans, 1991). Although this is an issue of individual medical importance, it is also a matter of national policy concern. Even though infant mortality rates by birth-weight category in the United States are among the lowest in the developed world, the overall infant mortality rates are among the highest. This statistical anomaly is because of the higher rates of preterm infants born in the low-birth-weight categories (Behrman, 1987).

Perhaps even more troubling is the mounting evidence that the incidence of low-weight births is rising. Joyce (1990) estimated that by 1990 the percentage of low-weight births among black females in New York City would exceed the rates of 20 years earlier, with most of the increase in the late 1980s. Although data limitations make conclusions tentative, Joyce offered the increase in substance abuse, particularly cocaine and crack, as the most likely cause of the increased incidence of low birth weight.

The challenge to medical practitioners is to develop programs that reduce the incidence of preterm delivery and low birth weight, especially among females of lower socioeconomic status, both white and black. Evidence seems to indicate that a comprehensive prenatal care program focusing on prematurity prevention may be able to reduce the incidence of low birth weight among females of all ages (Buescher et al., 1988). In fact, early prenatal care (beginning in the first trimester) among white teenagers has been shown to be associated with a 27-percent reduction in low-weight births (Frank et al., 1989).

Although the association between prenatal care and birth outcome is indisputable, there is still no clear cut causal relationship between the two. The primary issue addressed in this study is the cost effectiveness of prenatal care. Although proponents of prenatal care programs stress the potential cost savings, estimates vary widely depending on the population studied and the methodology used. Murray and Bernfield (1988) have estimated that the annual cost savings of adequate prenatal care is approximately $230 per mother (1986 dollars). This includes the cost savings from neonatal intensive care and rehospitalization within the first year. Monmaney (1988) reported that a Virginia program, if adopted statewide, could save the State almost $50 million annually by reducing the incidence of certain types of mental retardation due to low birth weight. If this program were adopted nationally, it would save between $14,000 and $30,000 for every low-birth-weight baby avoided.

Lifetime and aggregate estimates of savings tell an even more dramatic story. The National Commission to Prevent Infant Mortality (1991) has estimated the cost of lifetime custodial care of low-birth-weight babies to be as much as $500,000 per child. Additionally, this report estimated that 80 percent of the females at high risk for low-birth-weight babies can be identified in the first prenatal visit. The Congressional Office of Technology Assessment (1987) has estimated the cost of caring for babies who weigh less than 1,140 grams (2.5 pounds) at birth to be an average $140,000 per patient, bringing the annual cost of neonatal intensive care in the United States to a total of $1. …

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