Pediatrics Study Compares Costs of Baby Friendly and Non Baby Friendly Hospitals in the U.S.
Related Materials
A study published in Pediatrics titled, “Cost Comparison of Baby Friendly and Non Baby Friendly Hospitals in the United States,” by Jami DelliFraine, PhD, et al. reported that the cost difference between nursery services at a baby-friendly* hospital compared to a non-baby friendly hospital is not statistically significant. In this cost analysis, researchers examined records from the American Hospital Association and the Centers for Medicare and Medicaid Cost Reports to compare labor and delivery costs; specifically operational costs per delivery were calculated using a matched-pair analysis of a sample of baby-friendly and non-baby friendly U.S. hospitals. The authors conclude that “baby-friendly facilities have slightly higher costs than non-baby friendly facilities, ranging from 1.6% to 5%. No cost differences were found to be statistically significant.”
Although the findings of this cost analysis are interesting, they should be interpreted with caution. The authors did not determine the cost of becoming a baby-friendly hospital and acknowledge that their “costing model did not include any organizational or structural costs of gaining approval to pursue a baby-friendly designation, reorganizing departments, facility redesign to accommodate single birthing rooms, clinical education and training, and program implementation, but these costs can be significant up-front costs.” It is likely that these potentially high upfront costs could very well prohibit some hospitals from becoming baby-friendly.
A further limitation of this cost analysis is that the researchers were unable to control for sociodemographic factors of patients between the different hospitals. The authors note that baby-friendly hospitals are typically smaller hospitals located in specific regions of the country, serving a predominantly white, highly educated, and insured population, all characteristics of mothers who are more likely to breastfeed. With higher breastfeeding rates, such hospitals are likely to have less need for infant formula, compared to what could be needed in a hospital serving a more diverse population and having lower breastfeeding rates. Additionally, few baby-friendly hospitals are urban teaching hospitals, which typically serve ethnically diverse, high risk/high acuity and uninsured patients, all of which could impact breastfeeding rates and which could increase the average cost of delivery in a non-baby friendly hospital, if it were to become baby-friendly. Further, by not controlling for breastfeeding rates and socio-demographic factors among the different hospitals analyzed, residual confounding may exist, leading to potentially biased results. The authors conclude “it is unclear if the increase in costs associated with baby-friendly distinction would remain insignificant.”
In summary, before this study can be used for breastfeeding policy and hospital practice change, it is important that some of these unanswered questions be addressed and analyzed.
*Baby-Friendly Hospital Initiative was launched in 1991 by the World Health Organization and the United Nations International Children’s Emergency Fund to promote breastfeeding. In order for a hospital to be certified as “Baby-Friendly,” it must meet the “Ten Steps to Successful Breastfeeding,” available at: http://tensteps.org/ten-steps-successful-breastfeeding.shtml