240863 Cost-effectiveness of a Freestanding Birth Center as Compared to Usual Care

Monday, October 31, 2011: 5:10 PM

Ashley Palmer, MPP , Health Policy, Urban Institute, Washington, DC, DC
Embry M. Howell, MSPH, PhD , Health Policy Center, The Urban Institute, Washington, DC
Sarah Benatar, PhD , The Urban Institute, Washington, DC
Bowen Garrett, PhD , Health Policy Center, Urban Institute, Washington, DC
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related nursing

Learning Objectives:
Describe observed differences in maternal and infant outcomes for a freestanding birth center versus usual care Assess the cost-savings achieved by a freestanding birth center based on lower rates of cesareans and preterm births

Keywords: Birth Outcomes, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I conducted the cost-effectiveness portion of this research, and was a core team member on all aspects of this research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.