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Introduction
We conducted an economic analysis of the Nurse Family Partnership (NFP) in the context of three randomized trials we are carrying out to examine long-term effects of the NFP on maternal, child, and family functioning. The study we have conducted is a net-cost analysis from the standpoint of government spending.
The NFP is a program of prenatal and infancy home visiting by nurses in which they have three major goals:
- to improve the outcomes of pregnancy by helping women improve their prenatal health;
- to improve the child’s health and development by helping parents provide more competent care of their children the first two years of life; and
- to improve families’ economic self-sufficiency by helping parents develop a vision for their future and to help parents accomplish their goals by helping them plan the timing of future pregnancies, staying in school, and finding work.
Nurses visit low-income families in which mothers have had no previous pregnancies, beginning during pregnancy and following the children through the child’s second birthday.
Since 1993, when a study of the NFP on government expenditures was published on the first trial of the program conducted in Elmira, New York (Olds, Henderson, Phelps et al., 1993), policy makers have been interested in whether the effects found for the Elmira program persisted and whether they could be replicated in other populations. The Elmira study found that, for participants with low incomes at randomization, the cost of the program was recovered in terms of government program savings by the time the study child was 4 years old. The same program has been tested subsequently in randomized controlled trials in Memphis, Tennessee and Denver, Colorado, providing an opportunity for determining whether the results found in Elmira could be reproduced in these sites.
The program thus has been tested in three sites:
- Elmira, NY, with a sample of 400 families (primarily whites)
- Memphis, TN, with a sample of 743 families (primarily blacks)
- Denver, CO, with a sample of 735 families (including a large portion of Hispanics – 46%), with simultaneous tests of the program when delivered by paraprofessionals and by nurses, each compared to a randomly assigned control group.
The analysis presented in this report provides information on both the persistence of home visitation program effects on government expenditures and on their ability to be reproduced in different settings. We have analyzed government expenditures incurred by both comparison and treatment groups for all three sites. Because of the differential timing of the intervention in the three sites, we analyzed government expenditure data for different periods in the lives of the study families. For Elmira families, we analyzed government expenditures for the period from the birth of the study child until the family was interviewed during the child’s 15th year. For Memphis, we analyzed expenditures for the period from the study child’s birth until the family was interviewed when the child was 4 ½. For Denver, the period analyzed was birth to 4 years.
The approach we have taken is a net cost analysis, in this case, the net cost to government of providing the nurse home visitation program. Such an analysis takes into account not only government expenditures for study subjects but also taxes paid by study subjects and the cost of the nurse visitation program itself. Tax revenues are subtracted from government expenditures to arrive at a net government cost figure for each treatment group. By comparing the net government cost figures for the treatment and comparison groups, the net cost to government of the nurse visitation program can be determined. If government expenditures for the treatment group are lower than those for the comparison group and the difference exceeds visitation program costs, the intervention can be said to result in a net benefit for government.
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