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Are outcomes and care processes for preterm neonates influenced by health insurance status?
Gwieneverea D Brandon1, Susan Adeniyi-Jones, Sharon Kirkby
1Department of Pediatrics, Thomas Jefferson University/Nemours Children's Clinics, Philadelphia, Pennsylvania, USA. gwieneverea.brandon@gmail.com
Insights
Infants born prematurely to mothers with Medicaid managed care experienced worse health outcomes and longer hospital stays compared to those with private insurance. This suggests insurance type impacts neonatal care and results for vulnerable infants.
Area of Science:
- Neonatal Medicine
- Health Services Research
- Public Health
Background:
- Insurance status significantly influences healthcare access and outcomes.
- Premature neonates represent a vulnerable population with complex care needs.
- Understanding disparities in care for premature infants based on insurance is crucial for improving neonatal outcomes.
Purpose of the Study:
- To compare the processes of care for premature neonates based on maternal insurance status (Medicaid managed care vs. private insurance).
- To evaluate and identify differences in neonatal outcomes between premature infants with Medicaid managed care and those with private insurance.
Main Methods:
- Analysis of 24,151 premature infants (<37 weeks gestation) from the ParadigmHealth database (January 2001 - August 2005).
- Infants categorized by maternal insurance: private or Medicaid managed care.
- Comparison of demographic data, length of stay, respiratory care, nutritional and maturational milestones, adverse outcomes (necrotizing enterocolitis, sepsis, IVH, ROP, BPD, apnea, mortality), and discharge processes.
Main Results:
- Medicaid managed care infants had lower birth weight, lower Apgar scores, higher rates of necrotizing enterocolitis and sepsis, and longer hospital stays.
- No significant differences in gestational age, apnea, or bronchopulmonary dysplasia incidence.
- Despite similar feeding and respiratory milestone processes, Medicaid infants weaned to open cribs later and showed greater weight gain; private insurance infants were more likely to go home on oxygen and apnea monitors.
Conclusions:
- Medicaid managed care is independently associated with adverse neonatal outcomes in preterm infants.
- Differences in neonatal intensive care unit discharge processes exist based on insurance status.
- Insurance type plays a role in the well-being and care trajectory of premature neonates beyond birth parameters.
Objective:
The purpose of this work was to compare the processes of care and to evaluate outcomes of premature neonates delivered to women with Medicaid managed care versus private insurance.
Design/Methods:
All of the infants born at <37 weeks' gestation between January 2001 and August 2005 in the ParadigmHealth database were included in these analyses (n = 24151). Infants were categorized by maternal health insurance status as private insurance or Medicaid managed care and analyzed for differences in demographic data and length of stay. For survivors, differences in respiratory care, nutritional, and maturational milestones were assessed. In addition, age to wean to open crib, weight gain, home oxygen, and apnea monitor use were compared. Adverse outcomes, including necrotizing enterocolitis, sepsis, severe intraventricular hemorrhage, severe retinopathy of prematurity, bronchopulmonary dysplasia, apnea, and mortality, were compared. Statistical tests used were Students t test, chi(2), and Kruskall-Wallis test. Multiple logistic regression was performed after controlling for demographic variables.
Results:
Of the 24151 infants studied, 19046 (78.9%) had private insurance, and 5105 (21.1%) had Medicaid managed care. There were no differences in gestational age at birth; however, Medicaid managed care infants had lower birth weight, lower Apgar score at 5 minutes, increased incidence of necrotizing enterocolitis and bacterial sepsis, and longer length of stay. Of the surviving infants, more neonates with private insurance went home on oxygen and apnea monitors despite no differences found in the incidences of apnea or bronchopulmonary dysplasia between the groups. There were no differences in processes of care for feeding and respiratory milestones, but infants with Medicaid managed care weaned to an open crib later and had greater overall weight gain compared with infants with private insurance.
Conclusions:
We speculate that, in addition to the known impact of insurance status on well-being at birth, Medicaid managed care is independently associated with adverse neonatal outcomes in preterm infants, as well as differences in neonatal intensive care discharge processes.
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