The Effect of Preterm Infants on Stop Loss Insurance

A pregnant woman is considered “full term” at 37 weeks even though most natural births occur around week 40.  Preterm infants are born before 37 weeks.  Extremely preterm babies require medical intervention and hospital stays for weeks before going home with their parents.  Premature births are only 1.3% of claimants but represent over $67 million in paid stop-loss claims.  The cost of a premature birth with complications is 12 times higher than that of a normal full term birth; $55,393 for a preterm birth  compared to $5,085 for a normal full term birth in 2009 (1).

Trends in preterm infant care

The American Journal of Medicine released a study in September 2015 “Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012.”  This study followed 34,636 infants born at 22 – 28 weeks gestation.

Trends in medical treatment were revealed as:

  • Antenatal steroid use increased from 24% to 87%
  • Cesarean deliveries increased 44% to 64%
  • Delivery room intubation decreased from 80% to 65%

The results?

  • Late-onset sepsis declined from 37% to 27%
  • Bronchopulmonary dysplasia increased between 2009 and 2012 for infants at 26 to 27 weeks’ gestation
  • Extremely preterm survival increased slightly
    • 23 weeks’ gestation 27% to 33%
    • 24 weeks’ gestation 63% to 65%

Million Dollar Babies

In our July article on Stop Loss Top Ten Catastrophic Claims Conditions, which reviewed the 2015 Sun Life Financial Stop Loss Research Report we discussed that two of the top five costliest claims affect infants, “congenital anomalies” and “disorders relating to short gestation and low birth weight” totaled 7.7% of total paid stop-loss claims.

The Sun Life data showed that during 2011–2014, the top three highest-cost million-dollar claimant conditions were congenital anomalies (conditions present at birth), leukemia/lymphoma/multiple myeloma (cancers), and disorders relating to short gestation and low birth weight (premature births).

The Impact of Multiples

Assistive reproductive technologies have increased the occurrence of multiples, which also increases preterm births and health risks.   According to an article by HM:

Surprisingly, having twins is not simply double the cost of a single birth, it is instead nearly five times that of a single delivery. In fact, just three percent of births are multiples, yet they account for nearly 30 times the amount spent for singleton births. While 60 percent of the costs for singleton births are for maternal care, most of the expenses tied to multiple births are concentrated on care for the infants due to increased NICU admission rates and longer stays in that facility.

Stop Loss and Preterm Infants

To protect your organization from high value claims a prudent course of action is to help provide the expectant mother with the knowledge, resources, and screenings to remain healthy and increase her chances of a full term birth or to extend her pregnancy as long as possible.

 

(1) Study of 2009 data by The March of Dimes partnered with Truven Health Analytics, Inc.

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