A new University of Minnesota School of Public Health study finds Medicaid program coverage of doula services would likely be cost-effective because doula support is associated with lower rates of preterm and cesarean births. This study estimated that, on average, a Medicaid reimbursement rate of $986 for doula support would be offset by decreases in the costs associated with preterm and cesarean births.
The study findings were recently published in Birth.
“Previous studies have shown the health benefits of doula support for mothers and their babies and obstetricians recommend that people who are pregnant have doula support,” said study lead author and associate professor Dr. Katy Kozhimannil. “This analysis brings these recommendations into the context of the financial decisions Medicaid programs and other health plans make when they consider which services to cover.”
According to the National Vital Statistics Reports, in 2013 nearly one in nine births in the U.S. was preterm, and one in three was born by cesarean. More than one-third of all infant deaths in 2010 were attributed to preterm-related causes and preterm birth costs the U.S. health care system more than $26 billion annually.
This is the first study to show statistically lower rates of preterm birth among Medicaid beneficiaries with doula support. Given the longstanding racial disparities in preterm birth and infant mortality, the study’s findings on preterm birth are particularly relevant for equity concerns.
The study also found:
“Taken together, the strength of the research on known health benefits, recent clinical recommendations, and these new data on cost-effectiveness present a strong case for Medicaid programs and other health plans to consider including doula services as a covered benefit,” said Dr. Kozhimannil.
Currently, Minnesota, and Oregon have laws allowing Medicaid reimbursement for doula services, but uptake has been hampered by implementation challenges and low reimbursement rates.