Cost-effectiveness of a Freestanding Birth Center as Compared to Usual Care

The Family Health and Birth Center (FHBC) --a freestanding birth center in Washington, DC--serves primarily low income African-American women. In order to determine whether birth center care is cost-effective, we compared FHBC outcomes from birth certificates and costs from multiple data sources to those of a comparison group receiving usual care. The FHBC cohort included women who received at least two prenatal care visits at the FHBC in 2005-2008 (N= 875). The group includes women who delivered at the FHBC (18.5%) and at the hospital (81.5%). Using propensity scores, we constructed a matched comparison group along measurable risk factors from birth certificates. Logistic regression demonstrated significantly lower rates of cesarean section (p= 0.000) and preterm birth (p=0.005) for women in the FHBC cohort.

In order to determine whether these differences resulted in cost savings, we used national hospital costs for cesareans and vaginal births from the Hospital Cost and Utilization Project, national Medicaid physician fees from an Urban Institute study, and FHBC midwife and facility Medicaid payments to construct the cost of vaginal and cesarean births within each cohort, adjusting for the location and type of birth. An additional adjustment was applied to estimate NICU costs by gestational age. Using this method, FHBC care is significantly less costly than usual care. We conclude that care at a freestanding birth center can be a cost-effective way of improving birth outcomes for low income women.