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Over 2 million U.S. women of childbearing age live in counties with no maternity care

By Jeff Levin-Scherz, MD, MBA | October 28, 2022

Our population health leader weighs in on maternity care, colon cancer and colonoscopies, and the importance of exercise in this monthly update.
Health and Benefits|Benessere integrato
Risque de pandémie

The March of Dimes reports that one in 20 U.S. counties had less available maternity care in 2022 compared to 2020. About 2.2 million women (who had 150,000 babies last year) live in counties with no maternity care at all – no hospitals, no obstetricians and no midwives.

These “maternity deserts” are primarily rural, and women often must travel over an hour to reach a provider. Telemedicine helped some get prenatal care remotely, but state regulations limiting telemedicine to in-state providers that were lifted early in the pandemic are now returning.

The lack of local maternity care contributes to the U.S. maternal mortality rate, which is higher than any other developed country.

Implications for employers:

  • Employers can ensure their plans fully cover nurse midwives and birth centers, and effectively communicate this to members. Midwives and birth centers have lower rates of medical interventions and can expand access in communities that don’t have enough delivery volume to support other obstetrical providers.
  • Employers can fully cover telemedicine for perinatal care, although state regulations sometimes limit availability.
  • Perinatal Quality Collaboratives, now active in 47 states, help maternity providers increase quality of care. Employers can advocate for their medical carriers to provide incentives to providers that join these collaboratives. The first of these collaboratives, in California, was associated with a 50% drop in maternal mortality in just seven years.
  • As rural hospitals increasingly shutter their maternity units, employers should be aware that some members will have substantial travel requirements and need more time away from work to get necessary perinatal care.

New study shows that colonoscopies significantly reduce colon cancers

The New England Journal of Medicine reported on a randomized study of colonoscopy invitations given to almost 30,000 people ages 55 to 65 in Norway, Sweden and Poland. Those who were randomly assigned to this invitation were compared to about twice as many people who were not given this invitation. Of those who got the invitation, 42% actually got colonoscopies. The report does not say how many in the “usual care” group received a colonoscopy.

Those who got a colonoscopy invitation had statistically significantly fewer colon cancers than the control group. They had fewer colorectal cancer deaths too, although this did not reach statistical significance. All-cause mortality was not different between the two groups. The colonoscopies were performed from 2009 to 2014, so a mortality benefit could still reach statistical significance with more time. Researchers reported that it took 455 invitations to prevent one case of colorectal cancer.

Colonoscopy screening is more common in the U.S. than in these European countries. Other research has shown a substantial decrease in colorectal cancer deaths in the U.S. associated with an increase in colonoscopy.

Implications for employers:

  • This study shows that colorectal cancer screening did prevent colorectal cancer cases and might well show decreased mortality with longer follow-up.
  • Other methods of screening, including fecal immunohistochemical testing (FIT), could be less expensive and, because they require no preparation and no procedure, might attract a greater portion of the population to screening.
  • Many deaths from colorectal cancer are preventable and employers should continue to encourage evidence-based screening. National average commercial insurance screening rate is 62%.

Those who take more daily steps are less likely to die of heart disease or cancer

Researchers in the U.K. studied 78,500 people ages 40 to 79 by giving them an accelerometer for a week to calculate steps taken, and then followed participants for a median of seven years to see if they died of cancer or heart disease. There were statistically significantly fewer deaths from cancer and heart disease or any other cause in those who had more steps (up to 10,000 steps a day, after which additional steps were not associated with further decrease in risk).

This is a strong study because of its size and robust adjustment for other risks of death such as age or smoking. However, a week of accelerometer monitoring might not have represented usual exertion, and the population was non-diverse. Overall, this adds to evidence that exercise is good for overall health.

Implications for employers:

  • This study shows that those who exercise more have lower mortality. Other research has shown exercise is associated with better mental health and better productivity.
  • Many employers offer subsidies for gym or other physical fitness memberships.
  • Some employers offer financial incentives for exercise, although the evidence that this changes behavior is limited.
  • Employers can make it easier for employees to exercise at their workplace. For some employers this means providing an onsite gym, but for others it can be as simple as being within safe walking distance to a gym or encouraging walking meetings.

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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