Medicaid is collaborating with private insurers, health quality groups, and hospitals on a new initiative to discourage pregnant women and obstetricians from inducing labor before 39 weeks of pregnancy.
About one in 10 births in the U.S. is estimated to be scheduled early, although some estimates are higher, according to Politico. While an infant born at 37 or 38 weeks is not considered premature, recent data show that deliveries around that time—sometimes called "early term" births—have a higher risk of infant mortality.
Physicians believe that the last few weeks of pregnancy are important for fetal brain development, and infants born early face an increased risk of complications such as brain damage, respiratory issues, and digestive problems. Early delivery also raises the chances that the woman will have a caesarean section or delivery complications.
Encouraging women and their physicians to avoid unnecessary early deliveries could reduce these complications and related health care costs, according to Politico. Medicaid pays for more than 40% of births in the U.S., and lowering the induction rate by 50% could save the program $483 million annually and several billion dollars over a decade.
Cindy Mann, Medicaid director at CMS, noted that some states have enacted or are considering adding financial penalties for elective early births. However, federal Medicaid officials do not plan to pursue similar policies, she said.
Instead, HHS is focusing on hospitals to drive change. Earlier this year, HHS Secretary Kathleen Sebelius announced the Strong Start initiative, a voluntary quality program to boost prenatal care, reduce preterm births, and discourage early deliveries in nearly 3,200 U.S. hospitals. The initiative is part of the Partnership for Patients quality improvement project run by the Center for Medicare and Medicaid Innovation, which was created under the federal health reform law.
Meanwhile, some hospitals have had some success in reducing early births. Texas-based Seton Family of Hospitals has essentially eliminated elective early deliveries and experienced a corresponding drop in birth complications. A statewide effort promoting perinatal health in Ohio prevented about 8,236 early deliveries and 250 admissions to neonatal ICUs between September 2008 and March 2010 (Kenen, Politico, 4/2).