Study: ‘Drive-through’ deliveries save little money
Study: Drive-through’ deliveries save little money
Most maternity costs occur on first day
Three professors at Indiana University in Bloomington have released a study disputing insurers’ claims that an additional hospital day for new mothers costs thousands of dollars.
When the researchers studied 5,585 vaginal deliveries between 1993 and 1995, they found that most expenses for delivery occur on the first day, and the cost savings for one fewer day was 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 costs of visiting nurse services and readmissions because of postnatal 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 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 days 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.
Medicaid deliveries fall through loophole
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 smaller, Tai-Seale concludes.
"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, Tai-Seale says.
Although the Indiana University study did not look at readmissions, Tai-Seale expressed concern that postnatal complications caused by problems with nursing, such as jaundice and dehydration, could go initially unnoticed 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.
"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.
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