Are trends in the proportions of non-medically indicated inductions different by Medicaid status?

To determine whether Medicaid status influenced the effect of a quality improvement effort.

Using a data set consisting of the 2006 to 2010 vital statistics data linked with Medicaid status data, we identified non-medically indicated inductions between 36 0/7 and 38 6/7 weeks gestational age and compared rates of non-medically indicated inductions between women with Medicaid and all other payers. We also compared these rates in hospitals that did and did not participate in the Ohio Perinatal Quality Collaborative (OPQC).

A total of 232 935 births with gestational ages between 36 0/7 and 38 6/7 weeks were included in this study. In the sample, 32 371 births (13.9%) were non-medically indicated inductions. Overall, rates of non-medically indicated deliveries for all insurance types dropped over the course of the initiative. Interestingly, in OPQC participating hospitals, the Medicaid mothers' rates of non-medically indicated inductions prior to 39 weeks were well below rates for other insurance types prior to the initiative. By the end of the initiative, rates for all insurance types had dropped significantly but non-medically indicated inductions<39 weeks rates dropped more dramatically in the non-Medicaid mothers, resulting in higher rates for Medicaid than for non-Medicaid mothers.

Non-medically indicated deliveries decreased for women irrespective of Medicaid enrollment status. However, non-medically indicated delivery rates did not drop as sharply for women enrolled in Medicaid.