Impact of Financial Incentives for Prenatal Care on Birth Outcomes and Spending

Authors

  • Meredith B. Rosenthal,

    1. Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA
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    • Address correspondence to Meredith B. Rosenthal, Ph.D., Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA; e-mail: Meredith_rosenthal@harvard.edu. Zhonghe Li, M.S., is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Audra D. Robertson, M.D., M.P.H., is with the Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Boston, MA. Arnold Milstein, M.D., M.P.H., is with Mercer Health and Benefits, and with the Pacific Business Group on Health, both in San Francisco, CA.

  • Zhonghe Li,

    1. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA,
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  • Audra D. Robertson,

    1. Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Boston, MA,
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  • Arnold Milstein

    1. Mercer Health and Benefits, and with the Pacific Business Group on Health, both in San Francisco, CA
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Abstract

Objective. To evaluate the impact of offering US$100 each to patients and their obstetricians or midwives for timely and comprehensive prenatal care on low birth weight, neonatal intensive care admissions, and total pediatric health care spending in the first year of life.

Data Sources/Study Setting. Claims and enrollment profiles of the predominantly low-income and Hispanic participants of a union-sponsored, health insurance plan from 1998 to 2001.

Study Design. Panel data analysis of outcomes and spending for participants and nonparticipants using instrumental variables to account for selection bias.

Data Collection/Abstraction Methods. Data provided were analyzed using t-tests and chi-squared tests to compare maternal characteristics and birth outcomes for incentive program participants and nonparticipants, with and without instrumental variables to address selection bias. Adjusted variables were analyzed using logistic regression models.

Principle Findings. Participation in the incentive program was significantly associated with lower odds of neonatal intensive care unit admission (0.45; 95 percent CI, 0.23–0.88) and spending in the first year of life (estimated elasticity of −0.07; 95 percent CI, −0.12 to −0.01), but not low birth weight (0.53; 95 percent CI, 0.23–1.18).

Conclusion. The use of patient and physician incentives may be an effective mechanism for improving use of recommended prenatal care and associated outcomes, particularly among low-income women.

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