Impact of financial incentives for prenatal care on birth outcomes and spending.
OBJECTIVE
To evaluate the impact of offering US$100 each to patients and their obstetricians or midwives for timely and comprehensive prenatal care on low birth weight, neonatal intensive care admissions, and total pediatric health care spending in the first year of life.


METHODS
Claims and enrollment profiles of the predominantly low-income and Hispanic participants of a union-sponsored, health insurance plan from 1998 to 2001.


METHODS
Panel data analysis of outcomes and spending for participants and nonparticipants using instrumental variables to account for selection bias. DATA COLLECTION/ABSTRACTION METHODS: Data provided were analyzed using t-tests and chi-squared tests to compare maternal characteristics and birth outcomes for incentive program participants and nonparticipants, with and without instrumental variables to address selection bias. Adjusted variables were analyzed using logistic regression models.


RESULTS
Participation in the incentive program was significantly associated with lower odds of neonatal intensive care unit admission (0.45; 95 percent CI, 0.23-0.88) and spending in the first year of life (estimated elasticity of -0.07; 95 percent CI, -0.12 to -0.01), but not low birth weight (0.53; 95 percent CI, 0.23-1.18).


CONCLUSIONS
The use of patient and physician incentives may be an effective mechanism for improving use of recommended prenatal care and associated outcomes, particularly among low-income women.
Rosenthal
Meredith B
MB
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA. Meredith_rosenthal@harvard.edu
Li
Zhonghe
Z
Robertson
Audra D
AD
Milstein
Arnold
A
D000328:Adult; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006302:Health Services Research; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000191:economics* / Q000458:organization & administration; D010349:Patient Compliance / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology; D011256:Pregnancy Outcome / Q000191:economics* / Q000208:ethnology; D011295:Prenatal Care / Q000191:economics* / Q000458:organization & administration; D014481:United States