THE COST OF POOR BIRTH OUTCOMES IN EMPLOYER-SPONSORED HEALTH PLANS

OBJECTIVES. The authors examine the cost and incidence of poor birth o utcomes in employer-sponsored health insurance plans. METHODS. An exte nsive study of national inpatient and outpatient claims data for prena tal, delivery, and postnatal care of nearly 59,000 mother-infant pairs was conducted. All maternal and infant costs incurred over a 2-year p eriod were analyzed, and, furthermore, the longitudinal claims experie nce of a cohort of 20,000 mothers and infants was examined in detail. RESULTS. The study revealed that 25% of deliveries resulted in poor bi rth outcomes, which accounted for 40% of total costs over a 2-year per iod. Extrapolated nationwide, the net direct medical care cost of poor birth outcomes in employer plans has been estimated at approximately $5.6 billion for 1990, approximately 3% of aggregate after-tax corpora te profits that year. CONCLUSIONS. Costs related to maternity and infa nt care are a major source of cost for employer-sponsored health insur ance plans. Poor birth outcomes represent significantly higher cost fo r both the mother and infant at all stages of care-prenatal, at birth, and postnatal. To the extent that poor birth outcomes relate to mater nal behavior and are preventable, their very high and protracted cost may justify substantial health promotion activity by employers and ins urers.