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Hospital Encounters Within 1 Year Postpartum Across Insurance Types, Oregon 2012-2017
Menolly Kaufman1,2, K John McConnell2, Maria I Rodriguez2,3
1School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR.
Insights
Medicaid patients had more postpartum emergency visits and fewer postpartum visits than those with commercial plans. This suggests potential postpartum care access issues for Medicaid beneficiaries.
Area of Science:
- Health Services Research
- Maternal Health
- Health Insurance
Background:
- Limited understanding of postpartum care utilization patterns beyond the initial 6 weeks.
- Association between insurance type and postpartum care access is understudied.
Purpose of the Study:
- To compare postpartum hospital utilization and visit attendance by insurance type (Medicaid, high-deductible, commercial).
- To examine the relationship between postpartum visit attendance, insurance status, and hospital encounters.
Main Methods:
- Analysis of Oregon hospital births (2012-2017) using All Payer All Claims data.
- Time-to-event analysis with weighted Cox Proportional Hazard regressions.
- Multinomial propensity score matching to control for insurance type differences.
Main Results:
- 24.9% of births experienced at least one postpartum hospital encounter within a year.
- Medicaid births showed higher emergency department (ED) visit risk (HR 2.05) and lower visit attendance (HR 0.71) versus commercial plans.
- Among Medicaid beneficiaries, missing early postpartum visits correlated with reduced readmission (aHR 0.77) and ED visit risk (aHR 0.87).
Conclusions:
- Medicaid beneficiaries utilized emergency department care more frequently postpartum than those with commercial plans.
- Findings indicate potential disparities in postpartum care access for Medicaid enrollees.
Background:
Little is known about the timing and frequency of postpartum hospital encounters and postpartum visit attendance and how they may be associated with insurance types. Research on health insurance and its association with postpartum care utilization is often limited to the first 6 weeks.
Objective:
To assess whether postpartum utilization (hospital encounters within 1 year postpartum and postpartum visit attendance within 12 weeks) differs by insurance type at birth (Medicaid, high deductible health plans, and other commercial plans) and whether rates of hospital encounters differ by postpartum visit attendance and insurance status.
Methods:
Time-to-event analysis of Oregon hospital births from 2012 to 2017 using All Payer All Claims data. We conducted weighted Cox Proportional Hazard regressions and accounted for differences in insurance type at birth using multinomial propensity scores.
Results:
Among 202,167 hospital births, 24.9% of births had at least 1 hospital encounter within 1 year postpartum. Births funded by Medicaid had a higher risk of a postpartum emergency department (ED) visit (hazard ratio: 2.05, 95% CI: 1.99, 2.12) and lower postpartum visit attendance (hazard ratio: 0.71, 95% CI: 0.70, 0.72) compared with commercial plans. Among Medicaid beneficiaries, missing the postpartum visit in the first 6 weeks was associated with a lower risk of subsequent readmissions (adjusted hazard ratio 0.77, 95% CI: 0.68, 0.87) and ED visits (adjusted hazard ratio: 0.87 (0.85, 0.88).
Conclusions:
Medicaid beneficiaries received more care in the ED within 1 year postpartum compared with those enrolled in other commercial plans. This highlights potential issues in postpartum care access.
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