Visiting
my daughter every day in the NICU for nearly three weeks has allowed me a good look into an area of medicine I knew nothing about. You wouldn't have to spend much time there to understand why intensive neonatal care is a very costly service.
Health care spending per capita is much higher in the United States than in all other industrialized nations. See
this table. Yet, average life expectancy , a key indicator of health care quality, is lower in the United States than in many of those countries. See
this table.
Lifestyle factors might account for some of this disparity, but the numbers are sufficient to give one pause.
I am now wondering whether prenatal and neonatal care accounts for some of the disparity. In a tragic sort of way, inferior prenatal care could actually boost average life expectancy while lowering health care costs. Adequedate prenatal care may reduce the incidence of miscarriage, especially in the second half of pregnancy. Had my wife's perinatologist not detected her dilating cervix in the 22nd week of pregnancy, we would probably have lost our daughter. And she would have been a miscarriage statistic, not an infant mortality statistic. Our insurer and Medicaid (would covers premature infants as disabled persons) would be saving many, many thousands of dollars.
That's anecdotal evidence.
This is a little more comprehensive. Late fetal death rates are lower in the United States than in many industrialized countries. Here are some 2001 rates for selected countries, taken from the table:
United States - 3.2
Canada - 3.3
Germany - 3.9
Sweden - 3.8
United Kingdom - 5.3 (2000, latest available data)
France - 4.6 (1999, latest available data)
I need to find information on prenatal health expenditures in these and other countries. The web pages I've highligted don't provide data that specific. My guess is that they are lower.
I am also speculating that lower fetal rates translate into more premature babies requiring very costly care. I could be wrong about this. The ratio of early live births to miscarriages might be higher in countries with worse prenatal care. But the rate of live births in the late second/early third trimester, when intensive, expensive long-term care is required, is probably higher in the United States.
The question, then, is whether health care spending is higher in the United States in part because we spend tremendous amounts of money treating children who, had they been conceived in certain other countries, would not have been born.