An Analysis of the Costs and Effects of Three Levels of Maternity Services in West Philadelphia

Abstract

Due to high rates of low birthweight infants and inadequate prenatal care, two programs were implemented in West Philadelphia--Maternity Care Advocates and enriched Healthy Beginnings Plus (HBP). Using an observational design, an economic evaluation was performed comparing three groups of clients at two public health centers (N = 248): (a) basic maternity services (control), (b) basic services plus advocates (group A), and (c) basic services, advocates, and HBP (Group A+B; a midwifery practice). Care providers for the first two groups were nurse practitioners and physicians. Following data were collected on a sample of consecutive prenatal clients: (a) utilization of services (number of tests, prenatal visits, and emergency room visits), (b) all prenatal and delivery hospitalization charges for mothers and infants, and (c) outcomes (maternal and infant hospital length of stay; birthweight; and estimated gestational age at birth). To evaluate the advocates' efforts, the control and Group A were compared; all outcome measures, utilization of services, and charges were similar. Advocates' services added and lower hospital charges which resulted in statistically significantly lower total charges as compared to Group A. Client self-selection and differences in providers and hospitals preclude concluding that the HBP program was the primary reason for these differences. Regression models of the outcome measures were performed. In conclusion, neither of the intervention groups demonstrated higher infant birthweights nor an improvement in the adequacy of prenatal care when compared to the control in spite of an increase in expenditures on prenatal care.