(157) Another Reason to Address Social Determinants and Disparities: It Saves Money

Inherent in healthcare policy/medical practice changes are 2 components: 1. Does it improve care, & 2. How much does it cost? Serious attention is finally being paid to medical ramifications of Social Determinants of Healthcare, racism, and resultant inequitable care. This study focuses on the second question: What are the short and long-term financial consequences (FC) of disparate care? Cesarean delivery rates (CDR) by race/ethnic group, have higher levels of morbidity and mortality and serve as a surrogate for quality of care.

Study Design:

Using a GDP-based statistical dollar value metric of each life, we calculate long-term FC of disparate care. We compare representative states having generally perceived high and low spending on obstetrical care infrastructures and posed the following question: if CDR for Black patients were reduced to that of white patients, what FC would there be for short-term and long-term care. Long term costs are calculated as (additional hospital stay days X avg. cost per day) + (additional avg. recovery days X avg. daily GDP contribution).

Results:

Most states show considerably higher CDR and morbidity/mortality for Black patients vs. white.  Reducing Black CDR to white levels, short-term US savings would be $263M. Maternal and neonatal mortality rates (MMR and NMR) for Blacks are also higher [excess cost for Black MMR = $224M]. States with higher maternal and neonatal MR have significant impact on lifetime economic productivity.  Nationally, the annual cost of excess MMR & NMR is $3.147 Billion from increased costs, reduced incomes, and tax revenues.  In CA economic reductions are $471 per delivery; in GA it’s $1665.  

Conclusion:

In addition to general societal deleterious effects of disparities, the perception of “saving” money by not spending for better care is wrong. Long term State FC show no short-term savings and increased long term expenses. Ignoring (momentarily) the commonly articulated quality of care reasons for fixing the provision of care, it costs the US $ 3.634 Billion per year that could be better allocated.