NEONATAL HOSPITAL LENGTHS OF STAY, READMISSIONS, AND CHARGES

Objective. To evaluate trends in length of hospital stay, hospital cha rges, and readmission rates of Wisconsin newborns from 1989 through 19 94 in Light of recent policies requiring earlier discharges after deli very of newborns. Methodology, Two data sources were used: 1) 1989-199 4 Hospital Inpatient Discharge Data from the Wisconsin Office of Healt h Care information, and 2) 1994 birth certificate and matched infant m ortality data from the Wisconsin Center for Health Statistics. Average lengths of stay and average hospital (delivery and readmission) charg es were calculated, and readmission rates were estimated for full-term , premature, and sick newborns, Results. There were 368 955 full-term and 26 668 premature newborns in Wisconsin from 1989 through 1994, The average length of stay decreased by 24% in full-term newborns from 19 89 through 1994, while average hospital (delivery and readmission) cha rges rose over 40% during the same period, Average length of stay for premature infants increased by 24% while their hospital delivery charg es increased 214% during the study period, Readmission rates halved, y et charges per readmission doubled far full-term infants. More than tw ice as many full-term newborns were classified as sick in 1994 (43%) c ompared with 1989 (19%). Conclusions. Managed care efforts to control costs of neonatal care through earlier newborn discharge policies may have limited impact. Physicians or hospitals may be compensating for t hese policies by classifying more newborns as sick, thereby allowing f or longer hospital stays to be reimbursed by the insurance carriers. P remature infants, <7% of the total births, account for half of all hos pital. delivery charges. Efforts to reduce premature births may have a greater impact an neonatal health care costs than efforts to discharg e full-term newborns earlier.