Abstract

Although economic research has not yet produced accurate estimates of the total cost of prenatal substance exposure, there is growing evidence that this exposure may result in large short-term expenditures for newborn medical intensive care and probably even larger long-term medical, social, and educational expenditures. The annual short-term economic costs due to maternal smoking are estimated to be from $332 million to $652 million (in 1986 dollars). Long-term costs due to maternal smoking are estimated at $351 million to $852 million (in 1986 dollars) per year. In comparison, the short-term economic costs for perinatal cocaine exposure are estimated at $33 million to $650 million (in 1989 dollars). The cost estimates for cocaine vary widely because accurate estimates of the number of infants born exposed to this drug each year are not available.

Programs aimed at reducing the number of women who use drugs during pregnancy, and thus reducing the overall rate of low birth weight and the need for neonatal intensive care, may be extremely cost-effective. Because of the high cost of neonatal intensive care, even moderately effective programs that address maternal substance abuse may be cost-effective and may rapidly yield savings. Substantial long-term costs may also be saved by avoiding the need for subsequent medical care and for social and special education services that may be consequences of prenatal substance exposure.

One of the most striking pieces of medical news in the 1980s revealed the connection between high blood cholesterol and a person's likelihood of developing coronary artery disease. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health began the National Cholesterol Education Program, whose goal was to develop a national policy for reducing serum cholesterol. However, the panel that convened to formulate recommendations for screening and treatment was instructed not to consider cost in its deliberations. As Alan Garber and Judy Wagner point out in this article, failure to include costs in the development of guidelines such as these can have "far-reaching, unanticipated effects." This point is especially relevant to the new Agency for Health care Policy and Research (AHCPR) , which was formed as part of the 1989 budget reconciliation law. One of AHCPR's express mandates is to develop condition-specific treatment guidelines for nationwide use. "If the AHCPR guidelines show the same disregard for costs" that the cholesterol guidelines showed, the authors state, "they cannot be expected to guide health dollars to their most effective use."

Cholesterol Education Program: Hearing Before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, One Hundred First Congress, First Session

Questions of equity and efficiency have always plagued our national health-care system. Not all the billions spent in this area go for actual restoration of health. Many of the expenditures are for various procedures, tests, prescriptions, etc., that may or may not be necessary. How can we determine the optimum system of health care? Fuchs thinks that the application of the principles of economics can help in arriving at the right mix of market competition, government regulation, and professional control. He also devotes special attention to the impact of the increasing number of programs in health education and promotion. A topical analysis, which should be required reading for policymakers. Recommended for academic and large public libraries. - M. Balachandran, Univ. of Illinois Lib., Urbana-Champaign