No matter how you get your health insurance — and no matter what happens in Washington — we’re all in trouble if we don’t get serious about reducing costs. The ever-rising price of health care means fewer people will be able to afford coverage even with help from their employers or the government.
We spend nearly 18 percent of our GDP on health care yet still have outcomes below those of nations that spend considerably less. In the United States, we often pay for care that drives up costs without improving, and sometimes harming, the health of patients.
Where can we start to cut costs and improve health?
How about we stop paying for medical interventions that do not help people? Or let’s demand more. How about we stop paying for interventions that actually hurt people?
Here’s a good place to start: early elective deliveries.
We know that infants born at full term have the best health outcomes. For more than 30 years, the American College of Obstetricians and Gynecologists has advised its physician members not to perform early elective deliveries. Despite this fact, one in ten babies in the United States is born through a medically unnecessary early elective delivery, either by induction or Cesarean section, before 39 weeks gestation.
At the Quality Institute, we’re calling on New Jersey’s Medicaid plan and the State Health Benefits Program to stop paying for early elective deliveries. New Jersey should join Texas, Georgia, Michigan, New Mexico, New York and South Carolina and stop allowing Medicaid to reimburse for early elective deliveries.
Last month, Health Affairs published a study that found the Texas law ending Medicaid coverage of these deliveries altered how hospitals and physicians practice. The impact was powerful. Early elective deliveries fell by as much as 14 percent, which led to gains of almost five days in gestational age and six ounces in birth weight among babies affected by the policy.
The Texas law moved swiftly. It was introduced in May 2011, passed in June, and took affect in October. New Jersey can — and should — move just as quickly to make sure that New Jersey babies are never needlessly delivered before they are fully prepared for life outside the womb.
We are not talking about early births because the mother went into premature labor or for some other medical reason. The law would only affect deliveries scheduled simply because an earlier birth would be more convenient for the physician or mother.
According to The Leapfrog Group, data strongly suggest that early elective deliveries carry risks for both babies and mothers. Early deliveries increase the chance the baby will be admitted to the neonatal intensive care unit, resulting in longer stays and higher costs. Risks are higher for pneumonia. The March of Dimes tells women that their baby’s brain, lungs and liver continue to develop in the last week; the baby also has time to gain more weight. Additionally, an unsuccessfully induced labor will result in a Cesarean section, which carries its own additional risks (infections, bleeding, anesthesia complications) and high costs.
In our state, we have approximately 100,000 births each year. About three-to-four percent are early elective deliveries. Medicaid covers 42 percent of all births in New Jersey. That means each year Medicaid pays for costs associated with around 1,700 babies needlessly delivered early. We’re paying for poor care that puts mothers and their babies at risk. And given that babies born early are more likely to have complications, the savings could be substantial — and outcomes better for babies —if we stop paying for these deliveries.
Yes, we have seen the early elective deliveries in New Jersey decline by half since 2011 through transparency and education. But the percentage should be zero. In New Jersey, some hospitals deliver as much as 11 percent, 13 percent and even 60 percent of their babies early for no medical reason.
A law that says Medicaid will decline to pay for these births could spark a culture change at hospitals and obstetric practices with high rates.
We’ll be talking about early elective deliveries and other maternity issues — as well other ways to improve care and reduce costs — at our Spring All Council Conference on May 9 with our keynote speaker, Dr. Neel Shah, MD, MPP. Dr. Shah is an Assistant Professor at Harvard Medical School and Director of the Delivery Decisions Initiative at the Ariadne Labs for Health Systems Innovation. You can read more about Dr. Shah in this issue of Symptoms & Cures.
I look forward to you all joining us and adding your voices to our conversation about how we can improve our health care system and also reduce costs for the future.