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these costs is incurred in the form of neonatal intensive medical care services and among those born extremely preterm, the estimates provided in this chapter demonstrate that substantial incremental costs associated with preterm birth extend after the initial hospitalization and among the majority of infants born even just a few weeks preterm. Furthermore, the costs are not limited to medical care services. Substantial costs associated with preterm birth are due to early intervention and special education services associated with elevated rates of disabling conditions, and to lost household and labor market productivity over the life span.

Although relatively little research has been devoted to the maternal and caregiver costs associated with preterm birth, such costs are likely quite substantial. More research on the long-term and nonmedical care costs associated with preterm birth, including maternal and caregiver costs, needs to be conducted to have a more comprehensive understanding of its societal burden. Such research should also address the distribution of cost by gestational age and across public and private payers. Other areas that will be important to investigate include the ways in which reimbursement for obstetrical services may affect the costs of preterm birth. For example, do low reimbursement and high malpractice costs in certain regions of the country affect care? Given that preterm births generate revenue for hospitals through NICU charges, how might this affect health systems’ incentive to reduce preterm births? How this transpires may vary depending on the degree of integration of the health care system, and the specific mechanisms for reimbursement. Examining potential incentives to encourage health care providers and systems to reduce preterm births should be considered. This, of course, will require advances in the field to better understand causes of preterm birth and effective interventions to prevent its occurrence. The reader is referred to Chapter 14 for further discussion of the financing of health care and the organization and quality of perinatal and neonatal care. The results of these additional investigations will form the basis for more refined economic evaluations of interventions that may reduce the associated societal burden of preterm birth.

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