COST CONTAINMENT IN PERINATAL CARE

Abstract

Although costs of perinatal care have been addressed extensively in recent years, little has been said about containing these costs. In cost containment, emphasis should be given to: 1) prevention; and 2) effective/successful therapy, as unsuccessful therapy compounds the cost. A cost-effective approach to the antenatal period would include: appropriate antenatal referral of high risk patients; an anticipatory approach to the prevention of prematurity; prevention and/or antenatal treatment of congenital anomalies; and prevention of antenatal asphyxia. A cost-effective intrapartum approach would include: selection of delivery site by record of outcome (Level I, II, III, or home); use of fetal monitoring; and, continuous availability of on-site personnel for emergency Cesarean section and/or neonatal resuscitation. Postnatal cost-effective management would include: optimizing cost/benefit ratio of the physical plant, patient tests and procedures; optimizing patient load in an outcome oriented manner; limiting eligibility for neonatal intensive care; and, patient discharge whenever home care is safe and less expensive.