RAND Study Finds Longer Postpartum Hospital Stays Are Cost-effective

Lengthening the time some newborns and their mothers spend in the hospital is more cost-effective than other measures routinely taken to safeguard newborns, according to a study by RAND Health researchers.

The study is the first to examine the cost-effectiveness of extending the standard length of postpartum hospitalizations, which became an issue in the early 1990s when physician groups warned that shrinking postpartum stays threatened the health of newborns. The study appears in the April edition of the online version of the medical journal Pediatrics.

Driven by improved technology and cost-cutting efforts, discharge on the day after an uncomplicated vaginal delivery had become commonplace in many parts of the country by the early 1990s. Nationally, the average postpartum stay fell from 5 days in 1970 to less than 3 days by 1995.

In response to concerns about short hospitalizations—labeled “drive-through deliveries” by some critics—a federal law enacted in 1996 and many state laws now prohibit insurance plans from restricting postpartum hospital stays to less than 48 hours for a standard delivery or less than 96 hours for a Caesarean section.

“We wanted to know whether extending postpartum hospitalizations was a cost-effective way of safeguarding the health of newborns,” said Jesse Malkin, a RAND policy researcher and lead author of the report. “We found the cost appears reasonable when compared with other prevention efforts routinely taken to protect the health of newborns and infants.”

Analyzing data from previous studies and administrative records from more than 100,000 births in the state of Washington, the researchers estimated that the average cost of longer hospital stays would be about $20,000 to $95,000 for each newborn life-year saved.

Lengthening stays is more cost-effective than a medication routinely given to premature newborns to protect them against a common respiratory virus and is as cost-effective as a pneumonia vaccine recommended for all infants, according to the authors. It also falls within the reasonable cost-effectiveness range suggested by previous studies.

Researchers say they were surprised to find how low the cost is for extending hospital stays to meet the legislated standards. Among the births studied, researchers estimate hospital stays would need to be lengthened by about 15 hours, on average, costing no more than about $400 per mother and baby.

“Most babies and mothers do not require a lot of medical resources during the postpartum period,” Malkin said. “In most cases, it's basically a hotel stay where nurses and doctors check in periodically to make sure everything is OK.”

The evidence for and against early discharge remains inconclusive. While some studies have concluded that early discharge is safe, the RAND team and others have found that infants who are discharged early are more likely to be readmitted to the hospital. The RAND team also found that newborns who are discharged early are more likely to die during the first 28 days of life.

Malkin said that while there is some evidence that postpartum stays have lengthened since legislation addressed the issue, it's not clear that all newborns and mothers are being given the choice to stay 48 hours. Doctors may feel pressure from hospitals to discharge newborns sooner than that despite the federal law, which regulates the behavior of insurance companies rather than hospitals, Malkin said.

Other authors of the report are Steven Garber and Emmett Keeler of RAND, and Michael Broder of the Cerner Corp. The U.S. Agency for Healthcare Research and Quality provided support for the study.