A health initiative that both saves money and produces better results would have to be deemed a success. That appears to be the case with South Carolina’s new effort to reduce the number of early elective deliveries of babies at hospitals throughout the state.
The effort, called the Birth Outcomes Initiative, enlisted all 43 hospitals in the state that deliver babies to agree to stop elective deliveries before 39 weeks of gestation. Those deliveries – usually involving induced labor, Caesarean sections or both – often result in greater health problems for both the mother and child than births that are allowed to go to the full 39 weeks.
In some cases, of course, early deliveries are advisable for a variety of reasons relating to the health of the mother or child. But elective deliveries often are done simply for the convenience of the mother or the doctor.
Scheduling takes precedence over genuine health concerns. And in many cases, babies born at 37 and 38 weeks or earlier can suffer health problems that lead to costly treatments.
The American Academy of Family Physicians says that “elective induction more than doubles the Caesarean delivery rate,” and, on average, results in longer hospital stays for mothers. Yet despite the risks and recommendations by the American College of Obstetricians and Gynecologists against these deliveries, they still accounted for 10 percent of the births in South Carolina in 2011 – or more than 6,000 births.
The practice not only is potentially dangerous, it also is expensive. By cutting the number of elective deliveries in half, South Carolina saved an estimated $6 million in Medicaid costs for the first three months of this year alone – and improved health outcomes in the bargain.
The Birth Outcomes Initiative is a collaboration of state health agencies, hospital associations and charities. Those who launched the project first feared resistance from doctors and hospitals.
In the end, though, all involved in the initiative cooperated fully in reaching the goals. The initiative next hopes to tackle “non-evidence-based Caesarean deliveries,” which cost more than natural births and can mean poorer outcomes, even at full term, according to experts.
No state should adopt health protocols simply to save money if they significantly increase the risk to patients. But the Birth Outcomes Initiative has helped to reduce a medical procedure that increased the risk to pregnant women and their fetuses.
And, by doing so, the state also reduced medical expenses.
This mirrors the experience in other states that have programs to cut the number of elective deliveries. Ultimately, it seems likely that the new guidelines will be adopted nationwide.
We hope this isn’t the only area in which smarter protocols can both reduce medical costs and risks to patients at the same time. The rise in medical costs over the past decade has been alarming, and news of an easy way to lower those costs is welcome.