Employer-Sponsored Plan Expenditures for Infants Born Preterm

Abstract

BACKGROUND Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging. METHODS We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects. RESULTS We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ~$47 100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $78 000 per preterm infant and $14 billion nationally. CONCLUSION Preterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.

Metabolic Acidosis in Preterm Infants is Associated with a Longer Length of Stay in the Neonatal Intensive Care Unit

“…Preterm births account for approximately 10% of all births but disproportionately greater healthcare costs in the USA [1][2][3][4]. Predictors of extended neonatal intensive care unit (NICU) stay, such as intracranial haemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, and late-onset sepsis, all directly contribute to excess healthcare costs that average more than $US10,000 per case in hospital [5,6].…”

Current Resources for Evidence‐Based Practice, September/October 2019

“…LBW results in increased mortality and increased short‐ and long‐term morbidity. It also is very costly to the health care system, costing employers nationally $6 to $14 billion for the first year of life for preterm newborns without major anomalies …”

Impact of an integrated mother-preterm infant intervention on birth hospitalization charges

“…These adverse outcomes result in substantially greater healthcare utilization and expenditures during the birth hospitalization, childhood and into adulthood [2][3][4][5][6]. Employer-sponsored health plans estimated expenditures of $14 billion for preterm infants during the first year of life in 2015 [7]. Although comprising 9.1% of all births, preterm or low birth weight infants accounted for 43.4% of the total costs of birth hospitalizations in the 2009 Healthcare Cost and Utilization Project [8].…”