NCPA - National Center for Policy Analysis

Drive-Through Deliveries Not So Bad After All

September 24, 1999

A study of full-term births in Ohio covered by Medicaid found that "drive-through deliveries" did not increase the likelihood that infants would have to be hospitalized again, as some doctors had feared. Both private insurers and government health agencies have sought to limit unnecessary hospital stays in order to control costs, but there is continuing debate regarding whether cost-control measures affect the quality of care and health outcomes.

The new study, published in the Journal of the American Medical Association, covered 1991 to 1995, before passage of a federal law mandating that insurance companies cover at least 48 hours of hospitalization for newborns and their mothers. Researchers found that:

  • For the more than 100,000 newborns studied, the average length of stay decreased from 2.2 days in 1991 to 1.6 days in 1995.
  • The share sent home less than a day after a vaginal delivery or two days after a Caesarean birth increased from 21 percent to 59.8 percent during that time.
  • But the rates of rehospitalization within two weeks of discharge also went down, by 23 percent.

The researchers speculated that a campaign by some Ohio hospitals to better coordinate care for newborns after discharge may have been part of the reason for the improved outcome. Thus, although the babies' rates of rehospitalization declined, their rate of outpatient treatment increased 117 percent, and they were also slightly more likely to have a home care visit or go to the emergency room.

If babies are discharged too early, doctors may fail to detect heart and lung problems, intestinal obstructions and other major complications that can be fatal. Other studies have supported that belief. For instance, a 1997 study of 310,000 births in Washington state found that healthy newborns who remained hospitalized for more than a day generally fared better than those who went home a few hours after birth.

In the Ohio study, the two most common causes of rehospitalizations were jaundice and respiratory problems.

Source: Uma R. Kotagal et al., "Safety of Early Discharge for Medicaid Newborns," Journal of the American Medical Association, September 22/29, 1999.

 

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