From here to maternity - maternity care and portable benefits - Column
A pregnant woman who changes jobs no longer has to worry about continuing coverage for the care she and her baby need, thanks to the new federal health insurance legislation. Eliminating potential gaps is a wise move, because good prenatal care is the best way to prevent low birth weight and prematurity and could improve the United States’ dismal ranking of 24th in infant mortality among developed nations. Nearly 16 percent, or more than 7 million, working women had no health insurance in 1993, the most recent year for which statistics are known. Even women with coverage don’t always get early and regular prenatal care.
Increasing the use of prenatal care would not only improve the overall status of the country’s health but also reduce what is frequently the single largest component of employers’ health costs. The care for one complicated birth and one sickly newborn can run anywhere from $20,000 to more than $1 million, compared to about $6,400 for a normal delivery and healthy baby. Bear in mind, too, that women now comprise nearly half the nation’s workforce.
That’s why Miriam Jacobson of the Washington Business Group on Health (WBGH), says, “Healthy mothers and healthy babies mean a healthy bottom line.” WBGH recently tracked large companies’ attempts to improve outcomes and lower childbirth costs. On-site obstetricians, preconception appraisals and beepers for expectant fathers, Jacobson says, were among the most innovative practices.
“On-site prenatal programs don’t just save money, but are good for morale, productivity and employee commitment to a company,” says Ellen Cutler, director of worksite programs at the March of Dimes, which has helped more than 5,000 firms establish them.
First Chicago NBD began its onsite program, Babies and You, in 1987 to ensure that women, who comprise nearly two-thirds of the company’s 35,000 workers, get good prenatal care. The average cost of birth is now at $8,250 for program participants and $10,000 for nonparticipants. Women who complete the program have fewer C-sections and low birthweight babies.
Among the services provided are confidential preconception risk appraisals and prenatal classes, where pregnant women receive tips like taking a daily dose of folic acid to prevent fetal development of spina bifida. Ranked No. 2 on Working Women’s list of healthy companies, First Chicago rewards those who complete the program by the 16th week of pregnancy with a $300 credit toward their health plan’s deductible.
Removing the financial barrier to care helped Dallas-based Haggar Clothing lower childbirth costs as well. The manufacturer began paying for 100 percent of pregnancy-related care–everything from doctor visits and delivery fees to prenatal vitamins–in 1998, after discovering its low-wage workers often skimped on prenatal visits because they couldn’t afford the $500 co-pay. Top claims for Haggar’s 4,500 mostly female workers consistently included premature, low birthweight babies and complicated pregnancies.
To receive full coverage, Haggar employees must keep all regularly scheduled doctors’ appointments and get precertified with a utilization review company in the first trimester. In 1994, the cost per birth fell to $5,574, down from $6,119 in 1991.
An innovative partnership with the Weld County Health Department is making prenatal care more accessible for workers at Monfort, a meat packing firm headquartered in Greeley, Colo. The company had fully covered preventive services for its mostly Hispanic workforce since 1984, but a 1990 study revealed that many of the women weren’t getting prenatal care because of a lack of Spanish-speaking providers. The result? Treatment of premature babies amounted to fully 10 percent, or some $3 million, of Monfort’s medical costs. At the county health department, bilingual staff are on hand to provide family planning services, prenatal checkups, screening tests and well-baby care –all accessible to employees with no forms, co-pays or deductibles.
Expectant fathers are the target of a work/family program at Los Angeles Department of Water and Power (LADWP), where three out of four of the 9,500 employees are male. Men whose partners are pregnant attend classes where they’re encouraged to abstain from smoking, especially at home, support the expectant mothers’ need for healthy food and assume more household tasks. Fathers-to-be also are given beepers in the last month of pregnancy. For every $1 spent on its work/family programs, LADWP says it realizes at least $2.50 in savings.