Birth Hospitalization Costs and Days of Care for Mothers and Neonates in California, 2009-2011

Abstract

Objective: To provide population-based estimates of the hospital-related costs of maternal and newborn care, and how these vary by gestational age and birth weight. Study design: We conducted a retrospective analysis of 2009–2011 California in-hospital deliveries at non-Federal hospitals with the infant and maternal discharge data successfully (96%) linked to birth certificates. Cost-to-charge ratios were used to estimate costs from charges. Physician hospital payments were estimated by mean DRG-specific reimbursement and costs were adjusted for inflation to December 2017 values. After exclusions for incomplete or missing data, the final sample was 1,265,212. Results: Mean maternal costs for all in-hospital deliveries was $8,204, increasing to $13,154 for late preterm (32–36 weeks) and $22,702 for very preterm (<32 weeks) mothers. The mean cost for all newborns was $6,389: $2,433 for term infants, $22,102 for late preterm, $223,931 for very preterm infants, and $317,982 for extremely preterm infants (<28 weeks). Preterm infants were 8.1% of cases but incurred 60.9% of costs; for very preterm and extremely preterm infants these shares were 1.0%/36.5% and 0.4%/20.0%, respectively. Overall, mothers incurred 56% of the total costs during the delivery hospitalization. Conclusions: Both maternal and neonatal costs are skewed, with this being much more pronounced for infants. Preterm birth is much more expensive than term delivery, with the additional costs predominately incurred by the infants. The small share of infants who require extensive stays in neonatal intensive care incur a large share of neonatal costs, and these costs have increased over time.

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre‐eclampsia: A pragmatic guide for first‐trimester screening and prevention

“…Through linkage of the maternal and neonatal datasets, it is possible to show that the predominant driver for increased costs in preterm birth is neonatal care . While costs of maternal care rise 2.7‐fold for women who need to be delivered before 32 weeks of gestation, costs of neonatal care increase 35‐fold.…”

Maternal and infant predictors of infant mortality in California, 2007–2015

“…However, while better neonatal care saves lives, it is expensive: the economic impact of this increased survival rate in PTB is enormous, with an average cost of $317,982 for neonatal care for extremely preterm infants (<28 weeks). These costs have been increasing over time [19]. Prematurity and SGA independently influence infant mortality and are important factors influencing infant mortality.…”

“…Therefore, some women might have been analyzed more than once, as the study was undertaken on risk factors associated with individual pregnancies, and not on individual women. Finally, the evaluation of SGA and LGA depends on the method used to assign gestational age [19]. We employed the intrauterine growth curves developed and validated by Olsen et al in 2010 based on a racially diverse sample of the US population [20].…”

Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks’ Gestation

“…Being born extremely preterm is a major contributor to infant mortality and severe morbidities that incur a substantial cost burden to the health care system. [1][2][3] Fortunately, rates of in-hospital mortality and several major morbidities among these preterm infants have been declining. [4][5][6] Changes in perinatal and postnatal care practices are cited as potential causes for these decreases.…”