uthors feel that these outcomes also are attributable to midwives' constant attention, care, and aggressive style.
The use of nurse-midwives also contributes to the cost effectiveness of birth centers. First, midwife-managed care is less expensive than physician-managed care.
Moreover, midwife reimbursement is more likely to be covered by reliable funding sources rather than by patient sources. In this regard, Scupholme, DeJoseph, Strobino and Pain (1992) examined midwives' sources of income. The authors stated that:
On a national average, 40 percent of reimbursement for CMN (Certified Nurse-Midwife) services comes from Medicaid, 19 percent from health care insurance, and 15 percent from HMOs...
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