Disparities in Pregnancy Outcomes by Payer Status in Hawaii: 2005-2009

Problem: Almost a third of Hawaii's births are to women on Medicaid/Quest, however little is known about how their maternal and child health (MCH) outcomes compare with privately-insured women, who represent just over half of all births. Study Purpose: An analysis on 88,000 Hawaii births was completed to (1) identify factors associated with insurance status (Med-Quest vs. private insurance) and (2) estimate the associations between insurance status (Med-Quest vs. private insurance) and MCH outcomes. This paper is the third of four analyzing labor and delivery data from Hawaii's birthing hospitals. Method: Hospital discharge data representing all births in Hawaii hospitals from January 1, 2005 through June 30, 2009 were linked (mother to baby), extracted, and analyzed. Descriptive and inferential statistics were computed on mother and newborn variables to identify factors and estimate associations. Findings: Compared to privately insured women, mothers who were on Med-Quest were more likely to be: living in a rural area, younger (15-24), of Native Hawaiian or “Other” ethnicity and to reside in certain counties. In terms of MCH outcomes, mothers on Med-Quest were more likely to: be diagnosed as substance-using or have a sexually transmitted disease (STD), have a newborn with a moderate to extreme newborn illness or have a pre-term singleton birth.

Implications: Findings confirm that there is a disparity in pregnancy outcomes by payer status in Hawaii. This study can be used to inform policymakers and assist in developing interventions to improve the outcomes of Med-Quest clients in Hawaii.