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Maternal Health Care Insurance Dictates Obstetrical Care and Maternal-Fetal Outcome
Abstract Number: T1A-58
Abstract Type: Original Research
Introduction: Financial barriers in the form of health insurance may affect access to maternal health care services. Maternal health care disparities exist for the types of obstetric care and outcomes. The purpose of this study is to determine if maternal health care insurance effects the type of obstetrical care and maternal-fetal outcome.
Methods: After local IRB approval, the maternal quality assurance database was queried over a 3-year period from July 1, 2015 through June 30, 2018 (n=4199). Private insurance quality assurance indicators were compared to parturients with Medicaid/Medicare insurance. Interval data was analyzed using Mann-Whitney or t-test, nominal data using Chi-square with Odds Ratios (OR) as appropriate. Alpha was set to 0.05.
Results: Parturients with Private insurance (n=3352) tended to be older (Mean years: 29.1 v. 26.1, p < 0.0001), weigh more (median BMI: 31.7 v. 30.8, p = 0.004), present with less gravida (median 2 v. 3, p < 0.0001) and parity (median 2 v. 2, p < 0.0001), have more advanced gestation median 38.9 v. 38.0, (p < 0.0001), and have a neonate with a higher 5-minute Apgar score (median 9 v. 9, p = 0.009) than Medicaid/Medicare parturients (n = 847). Additionally, Medicaid/Medicare parturients were less likely to be admitted for induction with oxytocin (OR: 0.84, p = 0.047), receive labor epidural analgesia (OR: 0.79, p = 0.003), have a delivery supplemented with local anesthesia (OR: 0.53, p = 0.04), and have a primary cesarean section (OR: 0.66, p = 0.002). Conversely, Medicaid/Medicare parturients were more likely to be of African-American descent (OR: 1.75, p = 0.008), be a current known smoker (OR: 5.37, p < 0.0001), have a positive urine drug screen (OR: 3.39, p < 0.0001), and receive a general anesthetic (OR: 1.97, p < 0.0001), Table.
Discussion: Maternal health care insurance can factor into the use and quality of obstetrical care and outcome. The health care team must be acutely aware of the existence of and contributors to health disparities and be willing to work toward their elimination in order to provide the best care possible for all women. Implementation of comprehensive health care reform strategies can ensure all women and newborns have access to and receive comprehensive high quality, high-value maternity care.
Ref: J Health Popul Nutr. 2013;31(4): S81-S105.