On July 27, the Senate Homeland Security and Governmental Affairs Subcommittee on Federal Financial Management, Government Information, and International Security held a hearing on responsible resource management at the Health Resources and Services Administration (HRSA).
Chair Tom Coburn (R-OK) said the purpose of the hearing was to determine, “How do we get the best dollar return for what our goals are? How do we make health care affordable and accessible? How do we change the format in America from treating the disease to investing in health?”
Dr. Peter Van Dyck, associate administrator for the Maternal and Child Bureau at HRSA, testified on the Healthy Start program, which seeks to lower infant mortality and the number of low birth weight babies, and to reduce the number of preterm births. “Healthy Start was founded on the premise that communities can best develop and implement the strategies necessary to eliminate the factors contributing to infant mortality, low birth weight, and other adverse perinatal outcomes among their own residents, especially among populations at high risk. Healthy Start communities form local coalitions of women, their families, health care providers, businesses, and various public and private organizations that work together to address disparities in perinatal health,” he said. “The program now reaches into 96 communities in 37 states, the District of Columbia and Puerto Rico…Healthy Start was one of the pioneers in the use of women living in the community as outreach workers and home visitors. This approach achieves several things: It saves money (extending services of professionals through the use of lower cost paraprofessionals or lay workers), pregnant women respond better to other community based women who have ‘walked in their shoes’, and it has provided real and meaningful jobs to hundreds of unemployed or underemployed women in vulnerable communities.”
“Throughout the history of the program, it has been monitored by an independent council, known as the Secretary’s [of Health and Human Services] Advisory Committee on Infant Mortality, and the initial program design included a rigorous national evaluation. This evaluation, released in 2000, used matched comparison communities (that did not have a Healthy Start site) to the original 15 Healthy Start program communities. The evaluation revealed several statistically significant differences: more than half (eight) of the Healthy Start communities had improved adequacy of prenatal care utilization; four Healthy Start communities had declines in the preterm birth rate; three project areas had reductions in the low birth weight rate; and two Healthy Start communities had declines in the infant mortality rate of greater than 50 percent…Healthy Start has made proven impacts on participants’ access to prenatal care: in 1998, participants’ first trimester entry into prenatal care was only 41.8 percent; by 2003, this number had risen to 71.4 percent, an increase of 73 percent in five years.”
Ranking Member Tom Carper (D-DE) asked Dr. Van Dyck, “How do you evaluate the quality of the service you are providing?” Dr. Van Dyck told Sen. Carper that they review low birth weight and preterm birth rates: “The low birth weight rate has fallen from 12.1 percent in 1998 to 9.3 percent in 2004 [for program participants], even while the low birth weight rate has risen nationally.” Sen. Carper also asked why states with rising numbers of low birth weight babies and/or preterm births do not have a Healthy Start program. Dr. Van Dyck told the senator that “there’s a lot of competition for Healthy Start grants. There are two to three times as many applications as can be funded with the money we have available.”
Also testifying was Joyce Somsak, associate administrator for the Health Systems Bureau at HRSA, on bioterrorism and hospital preparedness.
