Cost study: ‘Drive-through’ deliveries save little
Cost study: Drive-through’ deliveries save little
Most maternity costs occur on Day 1
A study by three professors at Indiana University in Bloomington disputes insurers’ claims that an additional hospital day for new mothers costs thousands of dollars.1
When they studied 5,585 vaginal deliveries between 1993 and 1995, the professors found that most expenses for delivery occur on the first day, and the cost savings for one fewer day were only $208 per delivery. Insurers have estimated that it costs $1,000 to $2,000 per delivery for an additional day of care.
"On the day following delivery, new mothers need minimal nursing care — just clean sheets and Jell-O. It’s really not expensive," says Ming Tai-Seale, PhD, MPH, one of the researchers.
The researchers concluded that when the full costs of earlier discharge are taken into consideration, such as the cost of visiting nurse services and the cost of re-admissions because of post-natal complications, the savings associated with a shortened hospital stay may be even less. "There’s also the loss of patient good will when patients think they can benefit from another day in the hospital," says Tai-Seale
Along with Tai-Seale, researchers Marc Rodwin, JD, PhD, and Gerald Wedig, PhD, took advantage of the implementation of Medicaid managed care in Indiana to conduct the study. Their sample includes vaginal deliveries for 18 months before and 18 months after implementation of managed care. They determined that after the institution of Medicaid managed care, maternity lengths of stay for Medicaid patients dropped 22%, from 2.7 to 2.1 days.
The hospital where the patients were studied, Wishard Memorial Hospital, is a 317-bed inner-city tertiary care teaching hospital that serves more than 80% of the Medicaid population in Indiana. Of the patients studied, 85% were on Medicaid, 9% were self-paying, and 4% had private insurance.
Federal law now requires 48-hour coverage for vaginal deliveries of privately insured patients, but Medicaid patients are not covered by the mandate and often experience shortened lengths of stay following deliveries, Tai-Seale says. Cost savings for shortened lengths of stay for privately insured mothers may be even lower, she adds.
"I can’t generalize on how the savings would apply to privately insured patients, but research has shown that Medicaid patients are more expensive than other patients. If the potential savings on Medicaid patients is this small, it could be even smaller for privately insured patients," she says.
Although the Indiana University study did not look at re-admissions, Tai-Seale expressed concern that post-natal complications, such as jaundice and dehydration, caused by problems with nursing, could go unnoticed initially by new mothers.
In the study, the inflation-adjusted cost for deliveries was $2,334 before managed care and $2,134 after managed care. The average cost per day was $871 before managed care and $1,001 after managed care at Wishard, the study says.
"The average cost per day suggests that discharging a mother and child a day earlier will save about one thousand dollars. It ignores the decline in variable costs during the days when patients use of nursing care and other resources is much less intense in comparison with the day immediately following the birth," the researchers wrote.
Reference
1. Tai-Seale M, Rodwin M, Wedig G. Drive-through delivery: Where are the savings’? Medical Care Research and Review 1999; 56:30-36.
Source
• Ming Tai-Seale, PhD, MPH, Indiana University, Bloomington, IN. Phone: (812) 855-0563. E-mail: [email protected].
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.