Pennsylvania's Early Discharge law results in increased health care costs

May 13, 2000

Jefferson physician studies effectiveness and impact of legislation

A study, undertaken by neonatologists at Thomas Jefferson University Hospital, Philadelphia, to assess the effectiveness and impact of Pennsylvania's Early Discharge legislation, found that the law was effective in keeping new mothers and their babies in the hospital longer. The study also found that the legislation resulted in a significant increase in health care costs.

The law was enacted by the Pennsylvania legislature in April 1996 in response to a change in health care insurance coverage that permitted what was commonly referred to as "drive through deliveries." The new law extended the average maternity stay in a hospital, for both healthy mother and baby.

Jay Greenspan, M.D., professor of pediatrics at Jefferson Medical College of Thomas Jefferson University and neonatology division head in the Department of Pediatrics at Thomas Jefferson University Hospital, Jennifer Culhane, Ph. D., assistant professor of pediatrics, and their colleagues studied the records of all Philadelphia resident live births between 1994 and 1997.

The results will be reported at the Pediatric Academic Societies and the American Academy of Pediatrics joint meeting from May 12 to 16 in Boston. The law mandated that insurance companies pay for at least 48 hours of hospitalization for both mother and infants in the case of vaginal deliveries, and 96 hours in the case of a Cesarean delivery.

The researchers examined a total of 94,366 maternal records. They linked the Philadelphia resident live birth certificate data to the Pennsylvania Health Cost Containment Council Hospital Discharge Survey data. These data were compared to ensure quality. As a result of the legislation, they found that maternal median cost and length of stay per delivery rose from $5,200 to $6,800 and from 34 to 48 hours. These increasing trends were mirrored in infant cost and length of stay. The median infant cost and length of stay per delivery rose approximately $600 and 13 hours respectively.

"The length-of-stay legislation had a profound impact on maternal and infant discharge practices in Philadelphia," Dr. Greenspan notes. "As a direct result, an estimated $20 to $25 million was added to the annual health care costs associated with Philadelphia resident births. This amount is five times more than the Philadelphia Department of Public Health receives in Title V grant funding from the Commonwealth of Pennsylvania."

As a consequence of the study, Dr. Greenspan and his colleagues conclude that research should be undertaken to determine if this money is being spent wisely. Their next step, he says, is to look at data for readmissions to determine whether or not there were health benefits for mothers and infants associated with longer hospital stays.
Additional Contact: Phyllis Fisher
After Hours: 215-955-6060

Thomas Jefferson University

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