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Lengthening postpartum hospital stays to meet minimum Federal standards is cost effective

Because of concerns about the health effects on newborns of short postpartum stays, Congress and many State legislatures passed laws prohibiting health plans and insurers from restricting insurance coverage to fewer than 48 hours after vaginal deliveries or 96 hours after cesareans. Lengthening postpartum stays to federally mandated levels is cost effective, even for hospitals that take on additional capacity costs, according to a study supported by the Agency for Healthcare Research and Quality (HS09342).

Jesse D. Malkin, M.Phil, Ph.D., of RAND, and colleagues estimated social costs in 2000 U.S. dollars using several studies and survey data. They estimated life-years saved from reduced infant mortality due to lengthening stays to mandated times for 113,147 infants born in Washington State in 1989 or 1990 who had postpartum stays short enough to be affected by length of stay legislation. They estimated the lower-bound cost per newborn life-year saved was $19,800, when only neonatal deaths were considered. This compares favorably to other medical interventions commonly provided to newborns, such as neonatal intensive care for premature newborns at $55,000 per quality-adjusted life year (QALY). The corresponding upper-bound estimate was $94,800.

Even at hospitals that experienced additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seemed to be roughly equal to the benchmark of $100,000 per QALY considered to be cost effective. A 1 hour increase in length of stay was associated with a reduction in the probability of neonatal death of about 2.6 percent. The mean increase in estimated length of stay to conform to Federal mandate was 15 hours. The mean projected increases in total direct medical costs were $84 and $401 per birth for the lower and upper bounds, respectively.

See "Postpartum length of stay and newborn health: A cost-effectiveness analysis," by Dr. Malkin, Emmett Keeler, Ph.D, Michael S. Broder, M.D., M.S.H.S., and Steven Garber, Ph.D., in the April 2003 Pediatrics 3(4).

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