For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.
Objectives:Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This study draws on information from a previous study of the outcomes of birth center care to determine whether such care reduces Medicaid costs for low income women.
Methods:The study uses results from a study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D.C. Costs to Medicaid are derived from birth center data and from other national sources of the cost of obstetrical care.
Results:We estimate that birth center care could save an average of $1,163 per birth (2008 constant dollars), or $11.6 million per 10,000 births per year.
Conclusions:Medicaid is the leading payer for maternity services. As Medicaid faces continuing cost increases and budget constraints, policy makers should consider a larger role for midwives and birth centers in maternity care for low-risk Medicaid pregnant women.
This study identifies key barriers faced by primary care providers (PCP) in implementation of screening, brief intervention, and referral to treatment (SBIRT) services for substance use disorders among adolescents.Methods: The authors used mixed methods, including 12 key informant interviews and a survey with 75 PCPs, to identify key barriers to PCP implementation of SBIRT services.Results: Time constraints, challenges related to parental involvement, a perceived lack of effectiveness of brief intervention services, and lack of training in providing brief intervention were barriers to screening and brief intervention. Referral to treatment was frequently perceived as a challenge. Increased reimbursement and dedicated resources were important interventions for improving screening rates.Conclusions: Increased reimbursement could support workflow enhancements to improve the consistency of SBIRT procedures and alleviate time constraints. Consistent SBIRT applications for all adolescents could also be supported by increasing PCP training in brief intervention.
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