A study published online Thursday by the journal Birth suggests that offering women the support of a certified doula could save Medicaid and perhaps private insurers real money — nearly $1,000 a birth — by reducing cesarean and preterm births.
This NPR article about this study has been making the rounds lately in the doulasphere. The significance being that this is the first time a study has actually shown that doula care can save insurance companies money – an average of $986 per birth. Or is it?
What’s being left out is some data from the preliminary findings from last July:
When asked if they see a career as a doula working with Medicaid beneficiaries being financially viable many doulas said they would be pressured to have to take on private pay clients for two important reasons: 1) the length of time that had elapsed since the effective date of Medicaid reimbursement legislation without payment being numerated, and 2) the reimbursement rate (total of $411 for 6 prenatal visits and childbirth support) was below minimum necessary. Doulas almost universally noted that taking on private pay clients will become a financial necessity – given current reimbursement rates for Medicaid – if they want to make this their career, but it will most likely require them to seek clients outside of the communities that they are committed to serving.
Under the Minnesota program, the doula gets reimbursed $411 per birth. Several of the comments focus on the pay being woefully inadequate in comparison to the amount of work. One doula even said when she calculated how much she got paid for her first birth it was less than minimum wage.
This news isn’t as groundbreaking as you might think. In fact, it’s a concept that’s been brewing for a few years. Back in July 2013, Amy Gilliland wrote an article detailing the results of her study published in the Wisconsin Medical Journal. The findings were very similar – a cost savings of $400 to $500 per birth. The difference being that the study “gathered our statistics from used primarily inexperienced doulas.” Inexperienced doulas who are more likely to accept less pay for the experience of attending births and pursuing certification. Which isn’t such a bad thing.