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Prenatal Payments Could Improve Birth Outcomes

Ruzanna Harutyunyan's picture

While most health care professionals tout the importance of regular prenatal care throughout pregnancy, many women still do not get the care they need. Could providing financial incentives to patients or health care providers help improve compliance and —ultimately — outcomes?

That was the question raised by the authors of a new study, which appears in the journal Health Services Research online. They found that using incentives might not only improve the use of recommended care, but that it also could improve outcomes, especially for low-income women.

Examples of financial incentives were payments of $100 to patients and health care providers for “timely and comprehensive prenatal care.”

The researchers looked at administrative data and used information gleaned before and after the introduction of the Healthy Pregnancy Program — a program sponsored by the Culinary Health Fund of Las Vegas— to look at three maternal outcomes: rates of low birth weight, neonatal ICU (NICU) admission rates and spending in the first 18 years of life.

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Patient adherence to recommended prenatal care topped off at 76 percent, five times more than it was when the program began, according to estimates by medical managers. The researchers also found significant associations between participation in the incentive program and lower odds of admission to the NICU and lower spending in the first year of life. They found no significant association with low birth weight.

“Findings from the evaluation of this program suggest the potential value to health benefit sponsors (like the Culinary Health Fund) of employing incentives to encourage the use of comprehensive prenatal care and perhaps other preventive care measures,” said lead author Meredith Rosenthal, Ph.D.

Rosenthal is an associate professor of health economics and policy in the department of health policy and management at the Harvard School of Public Health.

“The study was unable to control for many of the behavioral risk factors and demographic factors that influence birth outcomes,” said Diane Ashton, deputy medical director of the March of Dimes. “Therefore it is difficult to definitively conclude that the incentives strongly influenced the outcomes and not underlying differences in the two groups.”

Such risk factors could include things like smoking and obesity.

“It is always possible in a non-experimental study that other factors were changing that caused the results and we are incorrectly attributing the improvements to the incentives,” Rosenthal said. However, “in light of the overall strengths and limitations of the study, I believe these results provide moderately strong evidence that incentives for patients and doctors — we can't separate out which mattered more — are effective in improving prenatal care adherence and the associated birth outcomes.”