South Carolina Kids Count
Hospital discharge records in South Carolina show that the excess cost of one year of hospitalization for low birthweight newborns is $163 million.
Dr. Baron Holmes, Project Director for South Carolina Kids Count, said, "Over 60% of the excess cost is paid by the South Carolina Medicaid program. The 10% of babies with low birthweight account for 57% of all newborn hospitalization cost; over three-fifths (62%) of low birthweight cost is very low birthweight babies under 3.3 pounds whose births cost an average of $94,378 each." The majority ($98 million or 60%) of this excess cost falls in 10 larger counties. However, the highest excess costs per newborn (45% or more above the SC average) occurs in ten mostly rural counties, but also including Richland and Florence, with high health and social risks associated with LBW and prematurity. These counties are listed below. (See Appendix A for tables showing the ranks and ratios of all the counties compared to the South Carolina average.)
Highest $ Excess Costs
| Rank | County | Excess Costs |
|---|---|---|
| 1 | Richland | $21,088,507 |
| 2 | Greenville | $17,949,625 |
| 3 | Spartanburg | $13,210,679 |
| 4 | Charleston | $9,800,954 |
| 5 | Florence | $8,950,444 |
| 6 | Lexington | $8,630,869 |
| 7 | Anderson | $5,457,520 |
| 8 | Sumter | $5,023,075 |
| 9 | York | $4,592,275 |
| 10 | Pickens | $4,159,124 |
Highest Excess Cost Per Newborn
| Rank | County | Excess Cost Per Newborn |
|---|---|---|
| 1 | Clarendon | $5,619.08 |
| 2 | Fairfield | $5,118.86 |
| 3 | Marlboro | $4,969.58 |
| 4 | Bamberg | $4,924.62 |
| 5 | Williamsburg | $4,901.22 |
| 6 | Richland | $4,847.19 |
| 7 | Florence | $4,699.22 |
| 8 | Marion | $4,634.97 |
| 9 | Cherokee | $4,404.90 |
| 10 | Barnwell | $4,340.94 |
Holmes added, "Healthcare, school, and institutionalization costs in subsequent years will substantially increase this excess cost of low birthweight and prematurity. The Medicaid program, other insurers, state agencies, and school districts will pay most of these additional costs. We can save ourselves a lot of money by getting our babies off to the right start. Most important is preventing the unnecessary consequence of disabilities and chronic health problems affecting too many children."
The ten counties with the highest Low Birthweight and Prematurity rates (23% or more above the state average) have health and social risk rates substantially above average (ranging from 12% to 47% above the SC average). The ten counties with the lowest LBW and Prematurity rates (7% to 20% below the SC average) do not display health and social risk factors uniformly below average; half are at or above the South Carolina rate by an average of 6%, while half are below the South Carolina rate by an average of 11%. This data suggests that the determinants of Low Birthweight and Prematurity are complex. Appendices A and B present in-depth data and analysis that probe the puzzling question of the causes and predictors of LBW and Prematurity.
COUNTY RATES COMPARED TO STATE AVERAGE
(% Above or Below SC Average)
Counties with Highest LBW and Prematurity Rates
| County | LBW & Prematurity | Risk Factors/Determinants | |
|---|---|---|---|
| 1 | Clarendon | +48% | +19% |
| 2 | Marlboro | +44% | +37% |
| 3 | Williamsburg | +39% | +19% |
| 4 | Allendale | +37% | +47% |
| 5 | Fairfield | +27% | +18% |
| 6 | Newberry | +26% | +27% |
| 7 | Chesterfield | +24% | +24% |
| 8 | Barnwell | +24% | +12% |
| 9 | Marion | +24% | +13% |
| 10 | Chesterfield | +23% | +25% |
Counties with Lowest LBW and Prematurity Rates
| County | LBW & Prematurity | Risk Factors / Determinants | |
|---|---|---|---|
| 1 | Beaufort | -20% | -13% |
| 2 | York | -20% | 0% |
| 3 | Lexington | -18% | -8% |
| 4 | Oconee | -16% | +10% |
| 5 | Pickens | -14% | -3% |
| 6 | Anderson | -12% | +1% |
| 7 | Greenville | -12% | -15% |
| 8 | Aiken | -8% | +3% |
| 9 | Dorchester | -8% | -17% |
| 10 | Horry | -7% | +16% |
Tables are available for each county showing the improvement required to reach the national average on each of The Right Start indicators. Also available are tables showing the rank, ratios, and the county rankings for each indicator for each Right Start indicator and for excess hospitalization cost and special education enrollment. With appropriate state-level support, our local communities across South Carolina must strengthen their partnerships to promote healthy births through the actions listed above. South Carolina's ranking will improve only when decisive action occurs in each community with support from state-level organizations.
The Right Start Report shows that during the 1990s South Carolina and the nation have made improvements on many measures of healthy births to caring, prepared parents. Overall, the problem rates for South Carolina reported in The Right Start declined by 9% between 1990 and 2002. This should come as no surprise in South Carolina, since recent governors have made healthy births a priority and enlisted the collaborative efforts of state and local organizations. There is much to celebrate and much still to accomplish.
| The good news is: | Rate Change 1990-2002: |
|---|---|
| Fewer births to teens; | -20% |
| Fewer second births to teens; | -20% |
| Fewer births to undereducated mothers; | -14% |
| Fewer births with little or no prenatal care; | -41% |
| Fewer births to mothers smoking during pregnancy. | -33% |
| The bad news is: | Rate Change 1990-2002: |
|---|---|
| More births to unmarried mothers; | +24% |
| More low birthweight babies; | +15% |
| More premature (pre-term) births. | +15% |
| South Carolina Rank: | 1990 | 2001 | 2002 |
|---|---|---|---|
| Births to teens | 43 | 43 | 44 |
| Births to teens already moms | 43 | 39 | 35 |
| Births to unmarried mothers | 42 | 47 | 45 |
| Births to mothers without high school education | 35 | 35 | 33 |
| Late or no prenatal care | 44 | 39 | 41 |
| Mothers smoking while pregnant | 21 | 20 | 28 |
| Low birthweight | 47 | 47 | 48 |
| Pre-term births | 43 | 46 | 47 |
| Average | 40 | 40 | 40 |
South Carolina's ranking failed to improve because other states have made similar progress. Since 1990, South Carolina has improved its ranking significantly only for repeat births to teen mothers. However, South Carolina ranked 44th or worse on 4 of the 8 indicators in 2002, with an overall average rank of 40th. We are not keeping up with our neighbors, North Carolina and Georgia, which improved their overall rankings to 33rd and 34th respectively.
South Carolina's progress has been achieved through hard work by many dedicated persons. Some highlights have been:
In order to continue our progress and to overcome the increasing problems with low birth weight and pre-term births, we must:
Holmes said, "The recent state fiscal crisis and budget cuts endanger our noteworthy progress over the past decade. Elected officials and other decision-makers should do everything in their power to sustain South Carolina's progress in assuring the right start for every baby born in the state. Continuing to invest in this effort is fiscally and morally responsible."
Appendix A (Microsoft Word Document)
Appendix B.
South Carolina Right Start State and County Profiles.
South Carolina Right Start County Rankings for Each Indicator.
Casey Foundation Right Start Online: South Carolina Profile