Online Program

Examining the Association between Medicaid Coverage and Preterm Births Using 2010-2013 National Vital Statistics Birth Data

Tuesday, November 3, 2015

Anne Markus, PhD, JD, MHS, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
Nicole Garro, MPH, Office of Government Affairs, March of Dimes, Washington, DC
Shannon Krohe, MPH(cand.), Health Policy and Management, Milken Institute School of Public Health, Washington, DC
Maya Gerstein, MPH, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
Cynthia Pellegrini, Office of Government Affairs, March of Dimes, Washington
While the rate of preterm birth has declined for the past six consecutive years, it remains a significant public health problem, affecting over 450,000 infants annually.  An Institute of Medicine report documents the causes and consequences of preterm births and estimates a societal burden of $26 billion annually.  Little is known about the burden of preterm birth among insured women with various types of insurance.  This study aimed to 1) determine the association between payer source and preterm births and 2) follow this relationship over a four-year period.

We conducted bivariate statistics and multivariate logistic regression on 2010-2013 National Vital Statistics Birth Data, controlling for known covariates available in the dataset, to evaluate the association between Medicaid coverage and preterm and to determine the strength of this association relative to private payer coverage.

Medicaid covers a lower number/percentage of all births than private insurance, but disproportionately covers preterm births, a statistically significant difference that holds over time.  In 2013, a higher percentage of all births Medicaid covered were preterm compared to private insurance (12.7% vs. 10.9%).  Among all preterm births, Medicaid covered a higher proportion than private insurance (48.9% vs. 42.3%).  Medicaid was 7.5% more likely to pay for a preterm birth than a full term birth, compared to private insurance and controlling for other relevant covariates. 

Effective interventions targeting pregnancy spacing, access to prenatal care, smoking cessation, and healthy weight exist and Medicaid should implement those more widely to improve birth outcomes and achieve substantial cost savings.

Learning Areas:

Administer health education strategies, interventions and programs
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Compare and contrast the association between payment source and other important factors and preterm births List the main factors associated with preterm births Discuss the importance of Medicaid coverage relative to other payment sources in supporting the costs of preterm births Formulate implications for Medicaid program improvements

Keyword(s): Perinatal Health, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Director, Public Policy Research, at the March of Dimes where I oversee the March of Dimes' maternal and child health policy research agenda, which informs our efforts to promote programs and policies that improve health outcomes for women and children. Among my research interests is health reform's impact on maternal and child health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.