My cynical eye-dropperful on why more US hospitals haven't sought BFHI
status is that they consider it to be too much work, for too little pay off.
Basically, they are not willing to give up what they perceive to be as major
benefits of receiving free formula and the more covert subsidies, while at
the same time, see very little direct benefit to the hospital for long term
improved health of baby.  Even in these days with capitated payments, most
managed care systems in the US do not kick in benefits to the hospitals
until an actual admission has occured (exception being Kaiser and few
others).  So, even if a hospital receives a prospective payment--it is
probably based upon a DRG-like system (diagnosis-related group) or even a
prospectively negotiated per diem.  So, what direct benefit do they reap?
I guess until we start putting everyone in the same life-boat where
preventive savings are realized by all, hospital administrators just don't
hear the ching, ching of money from BFHI.  And yes, it is true, that being
as ego-centric as we are in the US, internationalism is just not enough to
get them moving either.  BTW, I used to teach graduate-level hospital
administrators (and I survived)!
For what it's worth...
-- Chris Hafner-Eaton, PhD, MPH, CHES, IBCLC    [log in to unmask]

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