Medicaid and Commercially Insured Preterm Births in the United States
A 2013 March of Dimes study reported that birth hospitalization costs for preterm infants average approximately $54,000. Costs were greater when the mother's birth hospitalization and infant long-term costs were considered; however, this study did not provide detailed information about the healthcare resource utilization of preterm infants as a function of gestational age and separately for Medicaid and commercially insured infants. This study characterizes birth hospitalizations in terms of the length of stay (LOS), neonatal intensive care unit (NICU) admission, and costs for Medicaid and commercially insured infants in the United States.
Infants born between January 1, 2003 and June 30, 2013 were identified in the Truven Health MarketScan® Commercial Claims and Encounters (COM) and Multistate Medicaid (MED) databases. Full-term or preterm (<37 weeks' gestational age [wGA]) status was based on ICD-9-CM and DRG codes. Infants diagnosed with high-risk conditions (chronic lung disease of prematurity, congenital heart disease, cystic fibrosis, trisomy 21, immunodeficiencies, congenital lung anomalies, neuromuscular disease, or other genetic conditions, and infants who had organ transplants at or within 3 months of birth) were excluded. Costs are adjusted to 2013 US$.
Of the 2.1 million COM and 2.3 million MED births, 10.1% COM and 11.2% MED infants were coded as preterm. The average cost (standard deviation) was $56,477 ($120,566) for COM preterm infants and $39,360 ($103,573) for MED preterm infants, overall. Among preterm infants, 65% COM and 72% MED also had an ICD-9-CM code specifying specific gestational age. Among those with a specific GA code,> 75% of infants born at <35 wGA were admitted to the NICU (Figure 1). Mean LOS and costs increased with decreasing gestational age (Figure 2). COM and MED infants had similar birth hospitalization LOS and rates of NICU admissions; however, average costs were lower for MED infants.
Preterm infants have high healthcare utilization and cost at birth, which increases with decreasing gestational age. Infants from COM and MED populations have similar birth hospitalization experiences. The similar birth outcomes in these populations are in contrast to prior observations of worse health outcomes for MED infants after birth hospitalization discharge.
- Copyright © 2017 by the American Academy of Pediatrics