Bribes for better care?
Can cash rewards for pregnant moms improve prenatal care?
Offering financial incentives to expecting moms -- and their obstetricians or midwives -- may improve their use of prenatal care and make for healthier babies, new research hints.

Dr. Meredith B. Rosenthal of the Harvard School of Public Health in Boston and her colleagues looked at a program run by a union-sponsored health plan, the Culinary Health Fund of Las Vegas. Most plan members work in food service and hospitality occupations, and 40% are Hispanic.

In November 1999, the health plan launched its Healthy Pregnancy Program, which offers pregnant members $100 upon delivering their baby, if they began seeking prenatal care in their first trimester and continued to have regular prenatal care visits. The member's obstetrician or her midwife also receives $100 if these conditions are met.

When the program was first introduced, Rosenthal and her team note in the journal Health Services Research, just 14% of health plan members began receiving prenatal care in their first trimester of pregnancy, and more than 10% of their babies spent time in a neonatal intensive care unit (NICU).

By 2001, the researchers found, 76% of women in the health plan who had babies were participating in the Healthy Pregnancy Program. The researchers looked at data for 3,590 deliveries between 1998 and 2001, including 1,436 deliveries to Healthy Pregnancy Program participants. Enrollment in the program rose during the study period, with 73% of mothers who delivered babies in 2001 participating.

Among program participants, 4.5% had low birth weight babies and 5.2% had babies that needed NICU care, compared to 6% and 7.5%, respectively, for women who didn't enroll in the program. Enrollment in the program reduced the risk of having a low birth weight baby by 39%, the researchers found. While it also cut risk of NICU admission by 24%, this wasn't a statistically significant difference. Health care spending on a baby during his or her first year of life was also lower for Healthy Pregnancy Program participants.

While the researchers weren't able to look independently at adherence to prenatal care, the fact that enrollment in the program rose to about three-quarters of all deliveries --compared to just 14% of women receiving prenatal care before the program was introduced -- suggests that the proportion of women receiving appropriate prenatal care rose nearly five-fold, Rosenthal and her team write.

Also, the fact that the health plan spent about $235 less on care in the first year of life to babies born to program participants, compared to $200 for the incentive payments, suggests "that the overall financial consequences of the program may have been favorable from a payer's perspective," they contend.

Further research is needed, the researchers conclude, to determine if this approach could be extended to other settings and used to improve other health outcomes.

Is this something we could incorporate in South Africa? Or do you think it's unnecessary?

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