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We often give talks on what is wrong with the US healthcare system and highlight areas in which our healthcare system has outcomes that are far worse than those in other OECD countries. One such area is maternal mortality and morbidity. In fact, the US maternal mortality ratio of 20 maternal deaths per 100,000 live births is worst among developed countries (Hoyert 2020). We discussed this in detail in our Patient Safety Tips of the Week for January 8, 2019 Maternal Mortality in the Spotlight and December 8, 2020 Maternal Mortality: Looking in All the Wrong Places?. The latter column focused not only on maternal mortality but also discussed many maternal morbidities.
A new study from the Commonweatlh Fund notes that maternal morbidity is not just of concern from a human standpoint, but also has significant fiscal implications (ONeil 2021).
The Commonwealth study analyzed nine maternal morbidities (amniotic fluid embolism, cardiac arrest, gestational diabetes mellitus, hemorrhage, hypertensive disorders, maternal mental health conditions, renal disease, sepsis, venous thromboembolism) and considered not only direct medical costs but also societal costs (eg. loss of productivity, use of social services, etc.).
The estimated total costs of these nine maternal morbidity conditions for all US births in 2019 reached $32.3 billion from conception through the childs fifth birthday. This amounts to roughly $8,624 in additional costs to society for each maternalchild pair associated with 6.3 million pregnancies and 3.7 million births in the U.S. annually. Two-thirds of these costs occurred within the first year postpartum.
The largest costs included maternal mental health conditions ($18.1 billion), hypertensive disorders ($7.5 billion), gestational diabetes ($4.8 billion), and postpartum hemorrhage ($1.8 billion).
The health care system bore more than half these costs (58%), with the rest shouldered by employers, public social services programs, and other nonmedical sectors. These nonmedical costs included losses in productivity ($6.6 billion), costs associated with behavioral and developmental disorders in children ($6.5 billion), and increased use of social programs like SNAP, WIC, Medicaid, and TANF ($239 million).
The authors note these data likely underestimate the true societal costs of maternal morbidity, because data on the many nonmedical costs associated with the nine conditions is lacking in the research literature.
A word of caution is necessary when we discuss either the US infant mortality and maternal mortality/morbidity standing. Social issues, socioeconomic issues, access to healthcare insurance, access to healthcare provision, and societal disparities clearly impact those outcomes. The US spends proportionately far less on social programs than many of the OECD countries.
But the Commonwealth study makes it clear that greater focus on maternal morbidities may well result in savings to US society.
Our December 8, 2020 Patient Safety Tip of the Week Maternal Mortality: Looking in All the Wrong Places? and several of the other columns listed below describe maternal safety bundles and other interventions that we, on the healthcare side of the equation, can focus on addressing the problem of maternal morbidity and mortality.
Some of our previous columns on maternal and ob/gyn issues:
February 5, 2008 Reducing Errors in Obstetrical Care
February 2010 Joint Commission Sentinel Event Alert on Maternal Deaths
April 2010 RCA: Epidural Solution Infused Intravenously
July 20, 2010 More on the Weekend Effect/After-Hours Effect
August 2010 Surgical Case Listing Accuracy
September 7, 2010 Patient Safety in Ob/Gyn Settings
January 2011 Surgical Fires Not Just in High Risk Cases
February 8, 2011 Inducing Too Early
April 2011 Ob/Gyn Patient Safety Programs
April 24, 2012 Fire Hazard of Skin Preps Oxygen
July 2012 WHO Safe Childbirth Checklist
December 4, 2012 Unintentional Perioperative Hypothermia: A New Twist
September 2013 Full-Time Laborists Reduce C-Section Rates
October 2013 Challenging the 39-Week Campaign
November 2013 The Weekend Effect: Not One Simple Answer
January 2014 It MEOWS But Doesnt Purr
May 13, 2014 Perioperative Sleep Apnea: Human and Financial Impact
August 19, 2014 Some More Lessons Learned on Retained Surgical Items
November 3, 2015 Medication Errors in the OR - Part 2
February 7, 2017 Maternal Safety Bundles
January 23, 2018 Unintentional Hypothermia Back in Focus
January 8, 2019 Maternal Mortality in the Spotlight
December 8, 2020 Maternal Mortality: Looking in All the Wrong Places?
August 3, 2021 Obstetric Patients More At-Risk for Wrong Patient Orders
November 16, 2021 Cognitive Biases and Heuristics in the Delivery Room
Hoyert DL. Maternal Mortality Rates in the United States, 2019. Centers for Disease Control and Prevention 2020; Apr. 1, 2020
ONeil S, Platt I, Vohra D, et al. The High Costs of Maternal Morbidity Show Why We Need Greater Investment in Maternal Health. The Commonwealth Fund 2021;
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