Kozhimannil: Cost-Effectiveness (Birth, 2016)
$58.4M savings. Coverage grew from 2 to 26 states in 6 years.
$58.4M annual savings if doulas available to all Medicaid beneficiaries. 26 states + DC now cover doulas (up from 2 in 2020). Washington pays up to $3,500/client.
The follow-up 2016 Kozhimannil paper in Birth ran the economic analysis. If doula care were available to all US Medicaid beneficiaries, the projected annual savings would be 58.4 million dollars, primarily through reduced cesarean rates and reduced NICU admissions. The paper was instrumental in driving state-level Medicaid policy.
In 2020, two US states covered doula care under Medicaid. By 2026, 26 states plus DC do.
Washington pays up to 3,500 dollars per Medicaid client for doula services. The expansion has been one of the fastest policy shifts in US maternal health, driven directly by this cost-effectiveness evidence combined with the clinical outcome data.
$58.4M
Projected annual Medicaid savings
2
States covering doulas in 2020
26 + DC
States covering doulas by 2026
$3,500
Washington per-Medicaid-client rate
Why it matters
An intervention that saves money and improves outcomes should be easy to scale, and the doula data is one of the rare cases where policy is actually moving in the direction the evidence supports.
This is one finding from the research library behind How to Birth a Mother. Everything here traces back to a study, a dataset, or a systematic review.