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In the United States, where health care costs account for 15 percent of the gross domestic product, the costs of caring for premature infants have been the subject of some inquiry. The American public implicitly appears to be willing to accept the costs of preterm birth, in return for the improved survival of high-risk infants. It remains difficult to assess comprehensively the true costs of prematurity because of the fragmentation of the American health care system. There is a dearth of empirical literature examining the ethical concerns regarding the costs associated with preterm birth.

Several studies from the United States and abroad have examined predictors of the increased financial costs of caring for cohorts of premature infants during the neonatal period and beyond. Recent publications from Australia have evaluated the effectiveness and the efficiency of NICU care over the past 2 decades. In light of questions about the futility of expensive life-sustaining therapies, the costs of caring for nonsurvivors also have been examined and have been found to be small in proportion to the overall costs of caring for premature infants. One author explored whether ethically sound birth weight cutoffs would result in substantial savings to the health care system.

The long-term costs to society of supporting disabled individuals who were born premature have long been a subject of controversy. As a whole, American society has been willing to provide basic social services to support individuals who were born premature infants and seems unlikely to consider limiting health care spending on the basis of the prognosis for the infants’ future quality of life. This is in contrast to the model of several northern European countries, in which infants born at less than 26 weeks of gestational age are typically not resuscitated, primarily because of quality-of-life concerns.

Access to perinatal care has improved in recent years, as more and more women with high-risk pregnancies are receiving care in perinatal centers. Some empirical data have confirmed that premature and LBW infants fare better at higher-level perinatal centers. There are differences in perinatal outcomes by race, ethnicity, and maternal age; but studies relating ethical concerns to those differences are few and far between.

Empirical Data on the Financial Costs of Prematurity

Multiple studies have shown an inverse relationship between gestational age or birth weight and hospital charges during the neonatal period. Preterm or LBW infants are more likely to consume community health services and special education services than term or normal birth weight infants. Families incur substantial long-term costs. It is difficult to measure the true costs

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