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The New Mexico Breastfeeding Task Force believes that Medicaid and other third party
reimbursement for lactation consultants would be an extremely cost effective
exercise in preventive medicine. At present there is no mechanism in New Mexico |
Optimizing breastfeeding is an exceptionally worthy national goal. To quote the American
Academy of Pediatrics: " Extensive research, especially in recent years,
documents diverse and compelling advantages to infants, mothers, families, and
society from breastfeeding, and the use of human milk for infant feeding.
These include health, nutritional, immunologic, developmental, psychological,
social, economic, and environmental benefits."(1) |
Breastfeeding decreases the incidence or severity of a startling number of illnesses,
including diarrhea, otitis media, lower respiratory tract infection, bacteremia,
bacterial meningitis, botulism, urinary tract infection, and necrotizing
enterocolitis. The data for the foregoing is incontrovertible. It
is additionally highly likely and probably proven that breastfeeding is protective
against SIDS, insulin dependant diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma, lymphoblastic and myeloid leukemia, allergic diseases, other chronic digestive diseases (celiac disease, and liver disease due to alpha 1 anti-trypsin deficiency), dental malocclusion, and obesity.(1) By controlling obesity the incidence of type two diabetes can also be lessened. It has been shown that breastfeeding, by its favorable effect on later obesity, can decrease the incidence of type two diabetes among Pima Indians from 30% to 20%.(2) |
With respect to mothers, there is less risk of ovarian and pre-menopausal cancer,
and because of the delay in resumption of menstruation and ovulation, child spacing
is improved.(1) |
All of these benefits, of course, translate into cost savings. Direct
infant formula costs for a year range from $1404 to $1515 for name brand formula
and $815 to $1245 for discount brands.(4) The cost of a breastfeeding mother's
extra calories is $50 to $400 in first year.(1,4) An average family can
realize a savings of about $1000 for the first year. In tax payer terms,
WIC spent $546 million nationally in 1999 to purchase formula. |
Much more importantly, consider the savings to our medical care system as a result
of breastfeeding. A small body of data directly assesses cost savings,
but we believe we are only aware of the tip of the iceberg. The lowest estimates
published are in a Kaiser-Permanente study from the East Coast using 1992-1993
data which found an average total medical cost savings of $200 per breastfed
baby for the first year.(5) |
A Colorado study suggests a cost savings to Medicaid of $112 per breastfed infant
for the first 6 months of life.(6) A study in 1996 among Hmong women in
California assessed the cost savings to Medi-Cal, AFDC, food stamps, and WIC programs.
If these women breastfed each infant for six months, the cost savings
to the programs over a 7.5-year period were estimated from at least $3442
to as much as $6090 per family.(7) |
A study done in 1998 in Tucson looking at just three illnesses (otitis media, lower
respiratory infection, and gastrointestinal illness) found that there were 2033
excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions
per 1000 never-breastfed infants compared with 1000 infants exclusively
breastfed for 3 months. This translates to additional costs to
a managed care system of between $331 and $475 per never-breastfed infant during
the first year.(8) A summary paper in 1997 estimated the additional annual
national costs of the treatment of four medical conditions in never-breastfed
infants. Infant diarrhea in non-breastfed infants costs $291.3 million;
respiratory syncytial virus, $225 million; insulin dependent diabetes from 9.6
to 124.8 million; and otitis media $660 million.(9) Later figures
say that we spend $5.3 billion/year on otitis media alone,(10) and breastfeeding
can decrease the incidence by as much as 50%.(11) These financial issues are just beginning to be explored. Given the long term costs in our society of treating chronic problems such as diabetes, cancer, lymphoma, Crohn's disease, etc., the financial implications become overwhelming. A small percentage decrease in incidence of these illnesses which may be achieved through breastfeeding translates into many billions of dollars saved. Data from the PRAMS (Pregnancy Risk Assessment and Monitoring System) project indicates that New Mexico exceeded Healthy People 2010 goals of a 75% rate of initiation of breast feeding (78.1%).(12) However, we are failing badly in the 6-month goal of 50% continuation of breast-feeding. Over all, here in New Mexico, at two months only 46% of women are continuing to breast-feed. When one considers teens and/or low educational achievement, the figure drops to less than 30%. Four and six-month continuation data is presently not available, but if it were available, it would no doubt be appalling. Unfortunately, physicians who care for breastfed infants are often unable to devote the time necessary for counseling women to successfully resolve their breastfeeding problems. Additionally, there is a disturbing apathy and a knowledge deficiency among many of our colleagues with respect to breastfeeding. In spite of the known advantages, in a recent poll of pediatricians, the majority believed that breastfeeding and bottle feeding were equally acceptable methods of infant feeding.(13) Finally, because half the practitioners are male, they are precluded from effectively acting as peer counselors, even though they may be knowledgeable and caring. Education and counseling have always helped our patients, and intuitively, the same interventions should help in promoting breastfeeding success. Happily, there is data to show that the intervention of knowledgeable consultants can achieve remarkable success. For the most part this data has been generated among low-income women(14-16), although it includes middle class HMO members as well.(17) The former is of course the group we are most trying to reach with this reimbursement request. Poor women are also, certainly, members of the most vulnerable population where interventions are most likely to achieve the most significant results. We are absolutely convinced that reimbursement for lactation consultants would be extremely cost effective for New Mexico Medicaid and all third party payers. |
1.AAP Work Group on Breastfeeding. Policy Statement. Breastfeeding and
the use of human milk. Pediatrics. 1997;100(6):1035-1039 2.Pettitt D, et al. Breastfeeding and the incidence of non-insulin-dependant diabetes mellitus in Pima Indians. Lancet. 1997;350:166-168 3.Anderson JW, Johnstone BM, Remley DT. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr. 1999;70:525-535 4.Breastfeeding News. The Santa Fe Breast feeding Taskforce. July 2000 5.Hoey C, Ware JL. Economic advantages of breast-feeding in an HMO: setting a pilot study. Am J Manag Care. 1997;3(6):861-5 6.Montgomery DL, Splett PL. Economic benefit of breast-feeding infants enrolled in WIC. J Am Diet Assoc. 1997;97:379-85 7.Tuttle Cr, Dewey KG. Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmung women in California. J Am Diet Assoc. 1996;96:885-90 8.Ball TM, Wright AL. Health costs of formula-feeding in the first year of life. Pediatrics. 1999;103:870-876 9.Riordan JM. The cost of not breastfeeding: a commentary. J Hum Lact. 1997;13(2):93-7 10.Bondy J, Berman S, Glazner J, Lezotte D. Direct expenditures related to otitis media diagnosis: Extrapolations from a pediatric Medicaid cohort. Pediatrics. 2000;105: p. e72 11.Duncan B, Ey J, Holberg CJ, et al. Exclusive breast-feeding for at least 4 months protects against otitis media. Pediatrics. 1993;91:867-872 12.New Mexico Department of Health. Exploring NM Prams: Breastfeeding. Santa Fe, NM;July 1999 13.Schanler RJ, O'Connor KG, Lawrence RA. Pediatricians' practices and attitudes regarding breast feeding promotion. Pediatrics. 1999;103:35-44 14.Kistin N, Abramson R, Dublin P. Effect of peer counselors on breastfeeding initiation, exclusivity, and duration among low-income urban women. J Hum Lact. 1994;10:11-15 15.Brent NB, Redd B, Dworetz A, D'Amico F, Greenberg JJ. Breast-feeding in a low income population. Program to increase incidence and duration. Arch Pediatr Adolesc Med. 1995;149:798-803 16.Phillip Bl, Merewood A, Miller, Chawla BA, et al. Baby-friendly hospital initiative improves breastfeeding initiation rates in a US hospital setting. Pediatrics. 2001;108:677-681 17.Dashpande AD, Gazamararian. Breast-feeding education and support: association with the decision to breast-feed. Eff Clin Pract. 2000;3:141-3 |
The New Mexico Breastfeeding Task Force |
Renoir's Wife--Auguste Renoir |
Finally, cognitive development is almost certainly enhanced.(3) The implication for societal achievement of this effect is immeasurable. |
Medicaid for these women, or the institutions that employ them, to be reimbursed
for their consultative services. This exclusion is in spite of the fact
that lactation consultants meet rigid requirements of education and experience,
and have an internationally recognized credentialing board that certifies them
as healthcare professionals. |