The Net Benefit of Adequate Prenatal Care: New Estimates Incorporating Outcomes of both Infant and Mother

The Affordable Care Act extended prenatal care coverage to millions of women in a period when its net benefit has been subject to recent challenges.  To date, analyses of the effects of prenatal care on health outcomes and cost have suffered from the absence of population-based data, the reliance on cross-sectional and self-report rather than longitudinal and administrative data, a limited focus on maternal in addition to infant outcomes, as well as the absence of controls for critical drivers of utilization and cost.   This study addressed each of pitfalls, in terms of scope and methodological refinement, by utilizing a unique database of linked birth certificate records and inpatient hospital discharge abstracts (Utah Population Database) on the full Utah birth cohort in 2008.  The multivariate model assessed the effects of adequacy of care, based on gradations of the Kotelchuck Index, on total inpatient charges  at delivery and at one year post-partum for both infants and mothers, controlling for critical socioeconomic (e.g., race, maternal education, Medicaid eligibility) and birth-related (e.g., preterm, birth weight) factors.   Results from these analyses, coupled with estimates of costs of prenatal care, were used to generate estimates of net benefit of adequate prenatal care strictly in terms of cost savings to payers.   Estimates were made from the perspective of both Medicaid, which covers over a third of deliveries nationally, and all payers.  Estimates of national net benefit were generated through adjustments of the Utah results.  The findings establish significant net savings associated with adequate relative to intermediate and inadequate prenatal care, but also reinforce the difficulty of assessing such benefit among the riskiest births where prenatal care exceeds the norm.   Based on these findings, provision of adequate prenatal care meets the three National Quality Strategy (CMS) aims of better health care, better health, and reduced costs of care.