Contribution of Cost of Preterm Infants to the Total Cost of Infant Health Care in the United States.

Abstract

* Abbreviation: ICD-9-CM — : International Classification of Diseases, Ninth Revision, Clinical Modification Despite large expenditures on health care informatics across the United States, our ability to answer seemingly simple questions remains problematic. Administrative health databases contain limited clinical detail, databases remain poorly integrated, and barriers to access pose considerable challenges. The article by Grosse et al1 in this issue of Pediatrics is a case in point. Their seemingly simple question was: “What does it cost employers or employer-sponsored health plans to provide health care for preterm infants born with or without major birth defects during the first year of life?” The complex set of assumptions the authors deemed necessary to support their methods reveals why this question poses so many challenges. One challenge the authors faced was that of accurately identifying which live births were delivered preterm and which infants were diagnosed with major birth defects. Diagnoses, procedures, therapies, and duration of clinician interaction are typically revealed by health care claims records by using coding rubrics, including International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (although billing claims in the United States now use the International Classification of Diseases, 10th Revision, Clinical Modification rubric, its precursor was in use at the time of their study), Current Procedural Terminology codes, and specialized rubrics for prescriptions and laboratory services. The ICD-9-CM has no specific code for identifying preterm delivery, therefore the authors created a strategy by using codes for short gestation and low birth weight, noting that their approach … Address correspondence to Russell S. Kirby, PhD, MS, FACE, Department of Community and Family Health, USF College of Public Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612. E-mail: rkirby{at}health.usf.edu