Insurance and discrimination during prenatal care, labor, and delivery: Data from the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS)

Recent analyses of the Oregon PRAMS found that 18.5% of Oregon mothers reported discrimination by health care providers during prenatal care, labor, or delivery. Insurance status was one of the most frequently reported reasons for differential treatment (8.2%). In this study, we explored insurance-based discrimination among Oregon mothers in greater depth. Analyzing data from the Oregon PRAMS (1998-2001), we examined (1) who experiences insurance-based discrimination and how they differ from other mothers, and (2) the relationship between insurance-based discrimination and receipt of health care. We found that, of the 464 women reporting insurance-based discrimination, 2.8% had no insurance, 66.04% had Oregon Health Plan (OHP), and 19.23% had employer-sponsored insurance for their delivery. Mothers with incomes <$5,000 (AOR=3.86), those unable to pay bills during pregnancy (AOR=2.67), and those with OHP (AOR=2.85) or other/no insurance (AOR=4.46) for delivery were significantly more likely to report insurance-based discrimination, while mothers who were Hispanic (AOR=0.43) or had low birthweight babies (AOR=0.68) were significantly less likely. We also examined the relationship between insurance-based discrimination and health care variables. We found, for example, that insurance-based discrimination was significantly associated with not receiving prenatal care as early as mothers wanted (OR=1.3), but the relationship became non-significant when adjusted for sociodemographics. Our findings suggest that insurance status may affect patient-provider interactions. Experiencing discrimination may impact women's future behavior such as prenatal care initiation for subsequent pregnancies. Policies that lessen the influence of insurance, as well as provider education and training, could reduce discrimination and improve maternity health services.