NEONATAL INTENSIVE CARE UNIT

It has become accepted wisdom that “old people” are running up health care costs.  This widespread belief allows legislators – who are mostly beholden to big Pharma, big Insurance, and big Hospital – to ignore racism, poverty, and a corrupt health-care system. 

The metaphor “plugging in granny” would lead one to believe that the oldest patients account for costly intensive care treatment, and, hence, the largest hospital charges.  Examination of hospital discharge costs for 2007 – the latest year they are available through the Agency for Health Quality and Research – shows a far different reality.  Hospital charges of $1 million or more are heavily concentrated in the under five age category.  While 30% of these extremely large charges are for patients under five years of age, less than 10% are for patients above the age of seventy-nine.

With an infant mortality rate amongst the highest in the World, along with increasing multiple and premature births, it is no wonder that neonatal intensive care units are very busy these days.  The good news is that medical science has advanced to the point that babies weighing less than 750 grams, born after 23 weeks of gestation, have a high probability of surviving – three fourths leave the hospital.  Twenty years ago, these babies rarely survived.

The bad news is that many of these children will have a life-time health of problems.  Furthermore, many premature births could be prevented with proper prenatal care.  My analysis of the AHRQ database indicates that 60% of the $1 million NICU charges are reimbursed through Medicaid, which suggests to me they are incurred by a lower income population.  This should not surprise anyone.  As the discussion of Professor Sandra Lane’s book (previous post below), “Why Are Our Babies Dying?” indicates, neglect of inner-city, minority populations is largely responsible for the disgraceful state of infant health in the United States.