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Show visits and entered into prenatal care much later in gestation. The infant death rate for this group of patients was 18 per thousand live births compared to 9.2 deaths per thousand for non-Medicaid patients. Significantly, the average amount spent for babies born to Medicaid patients, and weighing fewer than 1500 grams, was $63,000. This is in comparison to an average of $2,700 spent for each infant born with a normal birthweight. It has long been established that prenatal care is cost effective, especially when the patient enters into care during the first trimester of pregnancy. The Department of Health estimated that of the patients who would be eligible for Medicaid, only one half to two thirds were actually enrolled. Surveys conducted by the department concluded that these patients were not aware of the efficacy of early and continued prenatal care, did not know how to obtain the care, and were concerned about their inability to pay. As the statistics deteriorated and the views of the patients became known, the Department of Health determined that a method needed to be developed which would make this care available to patients and would encourage them to respond to it. The program which was developed and the results which followed are truly impressive. The Solution An unique partnership was formed between the Utah State Department of Health, KUTV, Inc., Channel 2 (the NBC affiliate in Utah), Blue Cross/Blue Shield of Utah, the Utah Medical Association Foundation, and the March of Dimes. The resources of these partners were combined based on the following assumptions: 1. Utah's infant death rate is increasing. 2. The percentage of low birthweight babies is increasing. 3. Poor women have fewer prenatal visits. 4. Poor women have twice as many low birthweight babies. 5. More prenatal visits improve the outcome of pregnancy. 6. Low birthweight babies are more expensive. 7. Prenatal care is cost effective. The assumptions were all borne out by the studies of the Department of Health, which made it easy to look at the same parameters as endpoints in the evaluation. The result was a two year multi-faceted approach which combined a media and outreach program with an improved, enhanced, and expanded prenatal delivery service. The program is called Baby Your Baby. Several aspects of this program deserve special mention. First is the two year length of the initial program. That decision reflected the concern of all parties that if the program were only to last a single year, the necessary changes could not be implemented and observed. It also signaled to the community the unrelenting commitment of the sponsors. The target group was also unique: all pregnant women in Utah. This portion of the approach acknowledged that all pregnancies deserve care. While the real intent was to provide care to those who had previously not had it, it also served to put these same patients into the same emotional framework as their more affluent counterparts, underscoring their importance in the program. At the same time, the patients who had insurance and access to prenatal care, were also encouraged to engage the services of their physician earlier. Therefore, the entire issue of prenatal care and its obvious benefits would improve the health outcomes for all pregnant patients, not just those on Medicaid. All portions of the media were involved in the presentation of Baby Your Baby to the public. A recent article in the Journal of the American Medical Association (JAMA) (Dan, 1992) states that the 118 BABY YOUR BABY |