Keeping babies out of the Neonatal Intensive Care Unit should be an unambiguously a good thing if the avoidance is because the babies are being born healthier and in less need of intensive care immediately after birth. There are steps that hospitals, doctors and the rest of the healthcare system can do to tilt the field so that fewer babies are born in severe need of care. Those steps reduce suffering, increase happiness and lower costs.
Well, it is not an unambiguous good thing as this article from the Providence Journal shows an incentive problem:
Care New England reported a $40-million loss during the first half of its fiscal year (Oct. 1-March 31), with the deepest declines at Women & Infants Hospital and Pawtucket-based Memorial Hospital.
Women & Infants delivers the vast majority of babies in Rhode Island, with close to 9,000 births a year — 10 to 20 times the volume of any of the six other hospitals in Rhode Island with obstetrics programs.
Hospital officials have attributed the losses to declining birth rates and reduced volume in the neonatal intensive care unit due to improvements in the health of premature infants.
The specialized maternity care hospital is losing money because an expensive service is not being used as much because the population is healthier. From a cost curve perspective, this is a good thing. From a infant health perspective, this is a wonderful thing. From keeping that capacity open and available, this is a problem. One solution is that Rhode Island loses high end Ob-gyn capacity and they send all the hard cases up to Boston. That is a viable solution.
Another potential solution is to come up with some type of maternity care bundle or an alternative payment reform that throws money back to the hospital for the savings it realized by having fewer babies than expected go to the NICU.
As we try to bend the cost curve, we’re going to see more stories like this. There will be winners, there will be losers as we try to figure out how to make the population as a whole both healthier and using less expensive services to maintain or improve health.
Ohio Mom
Even if sending all the hard cases to Boston is the best solution here, I imagine there are other hospitals also taking hits on the decline of NICU cases that don’t have a “Boston” nearby.
Karen
recently read report that while we are doing better taking care of babies we are losing more women to after birth problems, we have become so focused on babies that some doctors are not being taught how to take care of mothers
there is also a push to no longer teacher doctors how to do an abortion, one report said they don’t even want to teach them how to do a D & C
dr. bloor
Similar story at St. Vincent’s in NYC in the 90’s. Once sophisticated treatments for HIV were on the scene, they had problems keeping beds occupied. Finally shut down in 2010.
As for Care New England, they’re a bit of a train wreck above and beyond any challenges posed by birthin’ healthy babies.
Gin & Tonic
Second that comment about Care New England. But Women & Infants is a wonderful place. Our son was born there, and my wife worked there for many years, although was hit by a round of layoffs a while back.
While the decline in NICU cases is indeed good for humans, one of the things that’s mentioned only in passing as a factor is demographics – RI is getting older, as the young people with drive and ambition move. If they have difficult obstetric cases they won’t have to travel to Boston or NY – they already live there.
Villago Delenda Est
This general problem (just not enough cases to sustain the operation) applies to rural hospitals in general.
It winds up being as much a political as an economic problem.
Karen
we now have corporation hospitals and treatment centers, instead of small private hospitals. yes, they can . afford better equipment but the price for one day standard room runs about $10,000 then everything is expensive a bag of saline costs about $1 and patients are changed $100 or more. I was in hospital and due to divorce had to pay for it since I moved to state that didn’t have ACA. I was in for 3 days and ended up paying $45,000
One of my pet peeves is that if a doctor or therapist pops head in and asking how you doing, you get charge for visit. Used to piss me off when they did this to step daughter as a CF patient who was usually in burn or cancer ward that head pop could cost $500. Even with having great insurance the copay was expensive. they are all in business of making money, the only ones who are the nurses that actually keep you alive and help you get healthy again
jharp
This is awesome. ObamaCare is working and improving lives.
Racer X
Congratulations. If a healthcare network is truly successful then you end up with an empty hospital. This is why healthcare requires a different financial model. Duh.