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Show per 1,000 live births. But as the Baby Your Baby Program was instituted, the rate dropped to 8.8 deaths per 1,000 live births during the first year of the program and continued to decline to 8.0 during the second year. The low birthweight percentage has continued to hover around 5.5% to 5.6%. Other important indices indicated a significant increase in the overall quality of care since the inception of the program as well. The number of pregnant patients seeking care in the first trimester of then-pregnancy rose from 68% in 1985 to 73% in 1989. The Kessner Index (see Appendix) assessing the adequacy of prenatal care rose from 57% in 1985 to 60% in 1988. A very promising statistic is that the number of babies under 2,500 grams dropped from 14% to 8.7%. And the most exciting part of all: The infant death rate dropped 46% during 1985-1989! By measuring the number of babies born in Diagnosis Related Group (DRG) 386, (Extreme Immaturity, Neonate) in 1985, it was determined that the State of Utah paid $4.8 million for 122 babies in this DRG, representing 5.3% of all births to Medicaid. Using 1989 data, it was projected that there would be 315 babies born into this category. At an average cost of $59,000 per baby, the state could have expected to pay about $18,600,000. The actual number of babies born in this category was 166 or about 2.8 % of all Medicaid births. The actual cost was $9,700,000. Therefore, the actual cost savings was $8.5 million. The simultaneous goals of increased access to care, increased quality of care, and decreased overall costs once again show the relationship of these important elements to each other. Discussion The target population chosen was a logical place to aim when attempting to increase access to care, especially given the background work by the Utah State Department of Health. If the proportion of pregnant females receiving prenatal care was shown to have increased, arguably, the Baby Your Baby Program could be called successful. It is difficult to separate the components of increased access due totally to this program from those that were a result of the SOBRA Program. The Interim Summary suggests that the total number of deliveries exceeds the projection. It would appear that the number of deliveries in excess of the expected number could be a result of the intervention. Costs of care seem to be getting most of the attention of those who reform the American health care system. Often, it appears that the suggested reform mechanism is a cost containment mechanism or a flat cap on expenditures. With this approach, particularly in a fixed or global budget situation, the potential is that when expensive procedures and/or diseases are paid, it is at the price of excluding either other patients or services. But for the Baby Your Baby Program, while the number of patients increased, the overall outlay decreased from the projected budget. While it cannot be expected that increasing access to health care will decrease health care costs across the board, (indeed, it would normally be expected that when more people are served it will cost more), in this case, that is exactly what happened. How can the decrease in overall costs be accounted for when more people received care? The answer is found in the increase in quantity as well as in quality of obstetrical services rendered to the target population. Because there were so many fewer small and/or premature babies delivered, the projected costs which were to care for all of these infants were never incurred. Therefore, the overall expenditure was less than anticipated. Again, it certainly cannot be predicted that when access to care is increased that the overall costs will decrease. But if the quality of care is increased through programs such as early intervention, the costs that would have been spent on complications that never occurred can be saved. An important determinant of success in this program was the ubiquitous and 120 BABY YOUR BABY |