Costs of Severe Maternal Morbidity During Pregnancy in US Commercially Insured and Medicaid Populations: An Observational Study

Objective To estimate the maternity-related cost of health care services in women with and without severe maternal morbidity (SMM). Methods Women with a live inpatient birth in the calendar year 2013 were identified in the MarketScan ® Commercial and Medicaid health insurance claims databases. Costs...

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Bibliographic Details
Published in:Maternal and child health journal 2020, Vol.24 (1), p.30-38
Main Authors: Vesco, Kimberly K., Ferrante, Shannon, Chen, Yong, Rhodes, Thomas, Black, Christopher M., Allen-Ramey, Felicia
Format: Article
Language:English
Subjects:
Adult
Childbirth
Cost of Illness
Female
Finance
Gynecology
Health Care Costs - statistics & numerical data
Health care expenditures
Health Services - economics
Health Services - statistics & numerical data
Hospital maternity services
Hospitalization - economics
Hospitalization - statistics & numerical data
Humans
Insurance Claim Review - statistics & numerical data
Managed Care Programs - statistics & numerical data
Maternal & child health
Maternal and Child Health
Medicaid
Medicaid - economics
Medicine
Medicine & Public Health
Morbidity
Observational studies
Outcome Assessment, Health Care
Pediatrics
Population Economics
Pregnancy
Pregnancy complications
Pregnancy Complications - economics
Public Health
Retrospective Studies
Sociology
Statistics
United States
Womens health
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Summary:Objective To estimate the maternity-related cost of health care services in women with and without severe maternal morbidity (SMM). Methods Women with a live inpatient birth in the calendar year 2013 were identified in the MarketScan ® Commercial and Medicaid health insurance claims databases. Costs were defined as the amounts paid by insurers plus out-of-pocket and third-party payments. Costs were calculated as total maternity-related costs and categorized as prenatal, delivery, and postpartum costs. SMM was identified using the CDC algorithm of 25 ICD-9 diagnostic and procedural codes. Variables associated with higher delivery costs were determined by multivariable linear regression analysis. Results A total of 750 women met the criteria for SMM in the Commercial population. The total, per-patient mean costs of care for women without and with SMM were $14,840 and $20,380, respectively. Delivery hospitalization costs were 76-77% of total mean costs for women without and with SMM. A total of 99 women met the criteria for SMM in the Medicaid population. The total, per-patient mean costs of care for women without and with SMM were $6894 and $10,134, respectively. Delivery costs were 71–72% of total costs. Variables independently predictive of increased delivery costs in both Commercial and Medicaid populations were delivery by cesarean section, multifetal gestation, gestational hypertension/preeclampsia, and obstetric infection. Conclusions The occurrence of SMM was associated with an increase in maternity-related costs of 37% in the Commercial and 47% in the Medicaid population. Some of the factors associated with increased delivery hospitalization costs may be prevented.
ISSN:1092-7875
1573-6628
DOI:10.1007/s10995-019-02819-z