The Sensible Knave

"I do not see that we are further along today than where Hume left us. The Humean predicament is the human predicament." - W.V.O. Quine

Sunday, October 02, 2005

Prenatal and Neonatal Care

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.


Blogger Cos said...

Highly unlikely. The bulk of our health care spending is at the end of life, not the beginning. If anything like this explains some of the disparity in health care spending between the US and other industrialized countries, it's that we spend "too much" prolonging the last few months of life.

Howard Dean had a great answer to a question about medical costs, at a town hall forum in New Hampshire two years ago, where he dealt with this. But I can't find my copy of the audio or transcription.

Of course the other huge problem with how we pay for medicine is our ridiculous privatized system, where insurance companies pay people to figure out how much care they can deny other people, and mediate doctor-patient relationships in an adversarial fashion; where businesses negotiate one by one for health care service for their employees and the self-employed have to do it on their own... there's so much overhead I don't think it can be measured. The effects of having so many competing interests at cross-purposes trying to deliver something that everyone needs, are staggering. Perhaps it employs more people than a single payer system would, but I doubt that's worth the drag on the entire economy that it causes, even in pure economic terms.

Compared to these things, what we spend on prenatal care as a country probably doesn't even get to "a drop in a pond" level. Well, okay, it probably does :)

12:20 PM  

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