Regional Insights: Better maternity care can reduce health care costs

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Although many people blame federal and state government deficits on wasteful spending, one of the biggest factors driving deficits is rapidly growing health care costs. High health care costs not only cause higher government expenditures on Medicare and Medicaid, but also increase the costs of providing health benefits to government employees.

Moreover, during a time when we're trying to recover from the recession, high and growing health care costs make it more expensive for businesses to hire new workers and make tight family budgets even tighter.

The good news is that there are many ways to reduce spending on health care that actually benefit patients. For example, preventing the thousands of hospital-acquired infections that occur every year in our region would save not only millions of dollars, but also hundreds of lives.

One of the biggest opportunities for reducing health care costs is improving the quality of maternity care. For most businesses, childbirth and newborn care is the largest or second largest (after heart care) category of hospital expenditures, and it's by far the largest category of hospital expenditures for state Medicaid programs. So even small improvements can result in large savings.

The place to start is with the most common hospital procedure in America -- the cesarean section. A C-section is a surgical delivery of a baby, rather than a normal, vaginal delivery. Not only does a C-section typically cost twice as much as a vaginal delivery, it is more likely to result in infections, injuries and other complications for both mothers and babies.

Yet today, nearly one-third of all babies in the country are delivered by C-section. Fifteen years ago, only 20 percent of babies were delivered by C-section, and in the 1960s the C-section rate was less than 5 percent.

In southwestern Pennsylvania, rates of C-sections vary widely. In 2008, the rate of C-sections for low-risk, first-time mothers in Allegheny County was 28.5 percent, but in Armstrong County it was 36.7 percent, while in Indiana County, it was 19.8 percent.

A major reason the rate of C-sections is high and growing is not because they're necessary but because they're convenient. Babies often take longer to arrive than their mothers or doctors might like, and C-sections often are used to shorten labor or to make babies adapt to the busy schedules that their mothers and doctors have.

Yet that temporary convenience can harm both babies and mothers, sometimes permanently.

C-sections are particularly problematic when they're used to deliver babies too early. The desire for convenience has resulted in a growing number of cases in which doctors use drugs or procedures to induce labor rather than let the pregnancy take its natural course.

About one-fourth of deliveries are now electively induced before the baby has reached full term (39 weeks). Yet research has shown that even babies born a few days too early are more likely to have problems such as developmental delays. Moreover, labor inductions before 39 weeks are more likely to result in expensive and risky C-sections, and the baby is more likely to spend time in an expensive neonatal intensive care unit.

These unfortunate trends can be reversed.

For example, a team of physicians and nurses at Pittsburgh's Magee-Womens Hospital of UPMC, using "Perfecting Patient Care" training they received from the Pittsburgh Regional Health Initiative, reduced the rate of early elective inductions by 64 percent and reduced the frequency of C-sections in elective inductions by 60 percent. They won the Fine Award from the Jewish Healthcare Foundation in recognition of their cutting-edge work.

There are additional opportunities for even greater savings in maternity care. For example:

• Birth centers are a safe option for healthy women with normal pregnancies who would rather deliver babies outside of a hospital setting, and they typically cost one-fourth as much as a hospital delivery. Pittsburgh is fortunate to have a nationally accredited, free-standing birth center (The Midwife Center for Birth & Women's Health) that provides this kind of choice.

• Fewer pregnancy complications and better birth outcomes could be achieved if more women received early and adequate prenatal care. Unfortunately, one in every five mothers (20 percent) in our region does not get adequate prenatal care, and the rate is shockingly poor in some parts of the region (more than one-third of mothers in Fayette, Greene, Indiana, Washington and Westmoreland counties did not receive appropriate prenatal care) and for minority populations (one-third of African-American mothers did not receive appropriate prenatal care).

A major contributor to all of these problems is the way health plans and Medicaid typically pay for maternity care. Hospitals are paid more for C-sections than for vaginal deliveries, creating an incentive to do more C-sections, and doctors are often paid similar amounts for both types of delivery, even though vaginal deliveries typically take longer and occur at inconvenient times. Doctors and hospitals make more money when mothers and babies have complications or when babies spend time in NICUs, rather than being rewarded for achieving better outcomes and reducing costs.

Some health plans and hospitals are changing this; for example, the Geisinger Health Plan in central Pennsylvania pays for maternity care based on outcomes, and the Geisinger Health System has significantly reduced C-sections and improved the quality of maternity care as a result.

Health plans in southwestern Pennsylvania should also begin paying for maternity care in ways that enable physicians to deliver higher quality, lower cost care.

We'll not only save money, but also have healthier babies and mothers as a result.


Harold D. Miller is president of Future Strategies LLC, and adjunct professor of public policy and management at Carnegie Mellon University. He publishes www.PittsburghFuture.blogspot.com , an Internet resource on regional economic and civic issues.


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