Denying postpartum sterilization to women with Emergency Medicaid does not reduce hospital charges

To assess the change in hospital reimbursement resulting from a 2004 policy requiring immigrants with Emergency Medicaid (EM) to pay for sterilization following vaginal delivery, we examined rates of tubal ligation following vaginal [postpartum bilateral tubal ligation (PPBTL)] and cesarean [cesarean section with bilateral tubal ligation (CSBTL)] deliveries, and compared these to a Standard Medicaid (SM) population unaffected by the policy.

Records of women who delivered at the Oregon Health and Science University between January 2000 and December 2006 were reviewed. Data examined included insurance, mode of delivery, sterilization and net revenue by delivery type.

A total of 3612 SM patients and 4220 EM patients delivered in the 5 years before the policy, and 1628 SM patients and 2066 EM patients delivered in the 2 years after the policy. The incidence of PPBTL among EM patients delivering vaginally dropped from 9.9% prepolicy to 0.9% postpolicy (p<.01). Concurrently, CSBTL among EM patients having cesarean section increased from 18.8% prepolicy to 23.5% postpolicy (p=.03). Notably, no significant change in PPBTL (pre: 8.7%, post: 9.2%, p=1.0) or CSBTL (pre: 22.9%, post: 22.9%, p=.62) occurred in the SM group. The net revenue change for all deliveries with tubal ligations in the EM population postpolicy was -US$5284.

Requiring out-of-pocket payment for sterilization following vaginal delivery in an EM population results in a decrease in PPBTL and an increase in CSBTL, and does not reduce hospital financial losses.