What’s Best for the Public Health of Montanans?

An ethics-based framework for reconsidering Montana’s maternal child health home visiting program selection

and award process

“This initiative will give children a healthier start…” US Health Secretary Sebelius

• ACA provides $1.5 billion to states for home visiting services to maternal, infant, and child population.

Deep, Unique Roots

Watershed Moment in MCH Policy and Funding

Partners in a Good Trend

Falling Behind

I. Who is at Risk?

II. Are Programs Effective?

III. Best Value for Public Funds?

• Every low birthweight baby or preterm birth costs states bewtween $28,000 and $40,000 in medical care costs.

• 6 - 10% of births will be premature and will account for 50% of Medicaid funds spent in infants

IV. Burdens on Citizens?

• Voluntary, but we must guard against stigma of targeting high risk folks.

• To the contrary, we can prevent and relieve health burdens suffered by vulnerable women, infants, and children.

• Save tax dollars for health care and social welfare costs.

Evidence of Program Effectiveness

• 79% reduction in abuse and neglect

• 35% less ER use• Higher vocabulary

skills at age 6• Higher reading and

math skills at age 9• 20% reduction in

welfare use

V. Is the Outcome Fair?

• Serve as many citizens as possible.

• Use the funds as intended and allocate it expediently.

• Allow for a variety of approaches.

• Involvement of local programs and citizens must be obtained.

“an unprecedented opportunity”

Public Accountability

• What do we tell our citizens?

• What do we tell our legislators?

• What do we tell ourselves?

References

• Principles of the Ethical Practice of Public Health• Cook and Hoas, Ethical Decisionmaking Process• Montana DPHHS Final MIECHV Plan • Pew Charitable Trust, Issue Brief, May 2010• Nurse Family Partnership (www.nursefamilypartnership.org)

• Olds, David, “Effects of Nurse Home Visiting on Maternal and Child Funcioning: Age-4 Follow-up of a Randomized Trial” Pediatrics (online at

http://pediatrics.aappublications.org.content/120/4/e832.full)

• Gostin, Lawrence O., ed., Public Health Law & Ethics, Regents of the University of California, 2010