Costs rung up in neonatal intensive care units have always been a drain for employer-sponsored health insurance. A new study in Pediatrics narrows the problem down, saying that the sizable amount of money spent on preterm infants in 2013 was spent on those with birth defects.
| Employer-sponsored health plan expenditures on infants during the first year of life, 2013 | ||||
|---|---|---|---|---|
| Number | Average expenditure | Aggregate expenditure | Percentage of total expenditure | |
| Preterm with major birth defects | 893 | $226,840 | $202,568,433 | 10.2% |
| Preterm without major birth defects | 12,401 | $42,620 | $528,533,100 | 26.7% |
| Nonpreterm with major birth defects | 3,691 | $63,939 | $235,998,923 | 11.9% |
| Nonpreterm without major birth defects | 156,532 | $6,450 | $1,009,562,526 | 50.9% |
| Source: Grosse SD et al., Pediatrics, October 2017. Data are from Truven Health Analytics MarketScan Commercial Research Database. | ||||
“Infants born with serious birth defects incur much higher costs if they are also born preterm,” the study notes.
Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of the costs incurred during infancy, the study found. The average expenditure for preterm infants with major birth defects was $226,840, compared with $42,620 for those born preterm without major birth defects.
The researchers conducted their study using a Truven database that includes a nationwide sample of claims and other data from employer-sponsored health plans. Extrapolating from the Truven data, they calculated that in 2013, employer-sponsored health plans paid between $6 billion and $14 billion for care associated with preterm births.
The cost of preterm infants may be higher for employer-sponsored plans, noted the team of researchers from the CDC and the University of Utah. Previous research has shown that Medicaid programs pay a third of what employer-sponsored plans do for preterm and low-birthweight infants.
