Despite all that we know about quality and how to improve the health care delivery system, we know of very few payment interventions that work across different health care delivery settings (in different states and localities) that improve quality and reduce costs. For example, we know that increasing hand-washing is a great way to reduce the spread of infection in a hospital. We don’t know exactly how to effectively target funding to change the behavior of providers across medical settings.
One intervention that we do know how to change behavior is to no longer pay for Early Elective Deliveries. Healthy babies should continue to gestate in their mother for 40 weeks. Obviously, there are cases where a baby will come earlier than that, however electing to induce cesarian births prior to this period is considered unsafe medical practice. It’s estimated that between 10 and 15% of all elective births are performed early without medical reason. The American College of Obstetricians and Gynecologists have recommended a Hard Stop policy against paying for Early Elective Deliveries.
As we’ve mentioned previously, Medicaid covers almost half of births in the United States, so if Medicaid stops paying for early elective deliveries, this would have a sizable impact. Texas and South Carolina have done just that.
Back in March we learned of some of the early success of South Carolina:
A new report published this month by the University of South Carolina Institute for Families in Society shows hospitals in the Palmetto State reduced the rate of “early elective inductions” among mothers who were at least one week removed from their due date from 8.8 percent in 2011 to about 4.4 percent in 2013. In fact, the Institute found 60 percent of all birthing hospitals in the state have stopped performing early elective inductions completely.