(SDAR) Does Perinatal Insurance Churn Impact Birth Outcomes? An Analysis of 2012-2015 Data from the Pregnancy Risk Asessment Monitoring System
Grantee: Regents of the University of Michigan
Principal Investigator: Lindsay K Admon
Project Number: R40MC32882
Project Date: 09/01/2019
Final Report
Age group(s)
- Women/Maternal
- Prenatal
- Perinatal/Infancy (0-12 months)
Abstract
In the United States, 1 in 10 neonates are born prematurely, impacting an estimated 450,000 births per year. Preterm birth is the leading cause of neonatal and infant mortality, and many survivors experience lifelong morbidity and disability. The United States ranks extremely poorly in preterm birth rates compared to peer nations and provides the costliest care to those born prematurely, an estimated 26 billion dollars per year. Preconception and prenatal care reduces preterm birth rates, neonatal intensive care unit admissions, and neonatal costs. Landmark analyses have recently revealed that extremely high proportions of delivering women experience disruptions and transitions ("churn") in health insurance coverage in the perinatal period. The most recent data estimate that 58% of all pregnant women experience a change in insurance in the nine months leading up to and including delivery, and 62% of women experience at least one month when they are uninsured during that time. The frequency of disruptions and transitions in insurance coverage in the perinatal period may contribute to the disparity in preterm birth rates between the US and other developed countries. Better understanding these relationships has been deemed critical research gap by the Maternal and Child Health Bureau (MCHB) at the Health Resources and Services Administration. The proposed analyses will use 2012-2015 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to generate updated estimates of insurance churn in the United States and draw comparisons across Medicaid expansion and non-expansion states (Aim 1), examine the relationship between insurance churn and preterm birth (Aim 2), and describe these relationships among women with chronic conditions (diabetes, hypertension, obesity, and depression) who are at among the highest risk for both insurance churn and preterm birth (Aim 3). These data are critical to informing health policy decisions surrounding insurance benefits design and eligibility and improving health outcomes for America's most vulnerable mothers and their infants.Publications
Listed is descending order by year published.
Daw JR, Kolenic GE, Dalton VK, Zivin K, Winkelman T, Kozhimannil KB, Admon LK: Racial and ethnic disparities in perinatal insurance coverage. Obstetrics and Gynecology. 2020;135(4):917-924. PM32168215/PMC7098441
Daw JR, Winkelman TNA, Kozhimannil KB, Dalton VK, Admon LK. Medicaid Expansion Improved Perinatal Insurance Continuity For Low-Income Women. Health Affairs. 2020;(39)9:1531-1539.
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