Just a few things as I am cleaning out my interesting article bucket:
Health Affairs has an intriguing study from Minnesota on the effectiveness of doulas to control costs for Medicaid births by encouraging fewer high intensity interventions:
Evidence suggests that when low-income individuals and people of color have access to doula care, they experience better outcomes than Medicaid recipients in general; that is, those with doula support have lower cesarean delivery rates and higher breastfeeding initiation rates.24,25 Thismeans taxpayers who finance 42% of births in Minnesota through the Medicaid program may see better value for the state’s financial investment in childbirth care when coverage benefits for pregnancy and childbirth also include the services of a doula….
Medicaid beneficiaries with doula support had a cesarean rate of 19.0% (95% CI=7.4, 20.5), significantly lower than the cesarean rate in the regional Medicaid population of 34.2% (95% CI=33.8, 34.5). Unadjusted for potential confounders, average preterm birth rate was not statistically different for doula-supported births, compared with Medicaid-funded births regionally.
From a cost control point of view, the big winner is the reduction in C-section rates by 15 points. That is massive. A non-complicated vaginal birth will cost slightly more than half that of a simple C-section. Recovery time for the mom tends to be less as she will have avoided major abdominal surgery as well. Doula’s are effectively professional advocates who can push back against our systemic desire to make everything a high tech enterprise that layers costs into everything even when the pay-off for those added costs are not significant. This to me is intriguing as hell.
And then there is this article from Benefits Pro concerning the proportion of births covered by private/commercial coverage:
A recent study published in the New England Journal of Medicine finds that PPACA has led to an increase in the percentage of births covered by private insurers, presumably as a result of the health law’s provision that requires insurers to cover the children of their beneficiaries until the age of 26.
The 2.5 percent increase in privately insured births among young mothers may seem small, but it represents a shift of hundreds of thousand of births to a different payment system.
Indeed, the rise in privately insured births has corresponded with a decline in the percentage of baby deliveries covered by Medicaid as well as drop in the number of uninsured deliveries.
It is good that more births are being covered as some previously uninsured births are now getting covered through either the Exchanges or through the U-26 stay on parents’ insurance provision of PPACA. Some births are being shifted from Medicaid (the payer of last resort for maternity care) to private insurance.
As a policy objective, I question whether it is a good idea to shift births from Medicaid to commercial insurance because commercial insurance costs a lot more per unit of service. It is the same quantity of services being consumed at a much higher unit rate. That is the crux of the American cost control problem.