Mottl-Santiago Julie, Dukhovny Dmitry, Feinberg Emily, Moore Jennifer, Parker Victoria, Cabral Howard, Bowser Diana, Declercq Gene
Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, USA.
Department of Pediatrics, Oregon Health and Sciences University, Portland, Oregon, USA.
Birth. 2025 Jun;52(2):299-307. doi: 10.1111/birt.12886. Epub 2024 Oct 11.
Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real-world data and a return-on-investment (ROI) analysis approach.
We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post-COVID-19 program costing estimates were also performed.
Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per-person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not.
The BBB-enhanced community doula program was cost-saving to payers and increased access to doula support for low-income people. Even with post-COVID-19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget-conscious Medicaid payers that doula services are affordable.
社区导乐是围产期保健工作者，在孕期、分娩期及产后提供同伴教育、资源引导和支持。有证据表明，导乐可改善护理体验、减少剖宫产并改善母乳喂养结局。然而，由于缺乏保险报销，在大多数州，低收入人群无法获得负担得起的社区导乐支持。为确定医疗补助对导乐服务报销的可负担性，有必要填补采用真实世界数据和投资回报率（ROI）分析方法的研究空白。
我们从医疗保健角度对强化社区导乐干预措施“婴儿最佳开端”（BBB）进行了投资回报率分析。收集了医疗保健和项目成本数据以及波士顿医疗中心一项常规产科护理随机对照试验（有或无BBB）的临床结局数据。投资回报率计算为医疗保健净节省额除以投资成本。还进行了新冠疫情后项目成本估算。
BBB组每位患者的平均医疗保健成本为18,969美元；常规护理组为20,121美元，节省了1,152美元。BBB项目成本平均每人971美元。投资回报率为18%。分娩住院和新生儿重症监护病房住院成本降低是最大的节省领域。使用拟议的医疗补助费用计算的人均项目成本产生了正投资回报，尽管2023年医院导乐项目的工资和薪水没有产生正回报。
BBB强化社区导乐项目对付款人而言节省了成本，并增加了低收入人群获得导乐支持的机会。即使在新冠疫情后项目成本增加的情况下，分析表明导乐支持在财务上仍然可行。这项研究应能让注重预算的医疗补助付款人放心，导乐服务是负担得起的。
