Title of Presentation

The Role of Antenatal and Intrapartum Financial Burden in Postpartum Care Utilization

Presenter Biography

Menolly Kaufman, MPH is an epidemiology PhD candidate in the School of Public Health and senior research associate at the Center for Health Systems Effectiveness at OHSU. Her research interests are how health policies, health systems, and health care financing impact maternal morbidity and well-being.

Institution

OHSU

Program/Major

Epidemiology

Degree

PhD

Presentation Type

Presentation

Start Date

6-4-2022 12:39 PM

End Date

6-4-2022 12:50 PM

Keywords

Maternal Health, Postpartum, Cost

Abstract

Background: Birthing people with commercial insurance tend to have better birth and postpartum health outcomes at the population level compared to Medicaid-funded births. However, the quality and cost of commercial insurances can vary widely, and it is increasingly common for private plans to have direct costs to the patient that are excessively high. Research is limited as to how high patient health care costs affect postpartum morbidity and access to care.

Objective: To assess how direct costs for health care (i.e. out-of-pocket spending) before and during birth impact postpartum care-seeking.

Methods: We conducted a retrospective cohort of commercially funded births in Oregon from 2012-2017 using an All-Payer All Claims database. Our primary exposure was out-of-pocket spending (deductibles, co-payments, and co-insurance, all health care costs that fall directly on the patient) for the birthing person from the first of the calendar year through delivery discharge. We utilized multivariable log-binomial regression to estimate how out-of-pocket spending impacts readmissions and emergency department visits within one-year postpartum and postpartum visit attendance within 12 weeks. We stratified the final models by pre-term birth status to assess if an out-of-pocket financial burden has a different impact on “higher risk” births.

Results: Among our population of commercial insured birthing people (N=78,147), 28.7% (N=22,406) had out-of-pocket health care costs over $2,500. Compared to births with $0 in out-of-pocket financial burden through delivery discharge, births with over $5,000 were 15% less likely to attend their comprehensive postpartum visit within 12 weeks (RR: 0.85, 95% CI: 0.83, 0.88) and 20% less visit the emergency department (RR: 0.80, 95% CI: 0.73, 0.88). We observed no statistically significant differences between out-of-pocket financial burden and readmissions.

Conclusion: The financial burden of health care may influence care-seeking, including for birthing and postpartum people. As policymakers and clinicians seek solutions to reduce inequities in postpartum health outcomes, the financial burden related to birth should be considered.

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Apr 6th, 12:39 PM Apr 6th, 12:50 PM

The Role of Antenatal and Intrapartum Financial Burden in Postpartum Care Utilization

Background: Birthing people with commercial insurance tend to have better birth and postpartum health outcomes at the population level compared to Medicaid-funded births. However, the quality and cost of commercial insurances can vary widely, and it is increasingly common for private plans to have direct costs to the patient that are excessively high. Research is limited as to how high patient health care costs affect postpartum morbidity and access to care.

Objective: To assess how direct costs for health care (i.e. out-of-pocket spending) before and during birth impact postpartum care-seeking.

Methods: We conducted a retrospective cohort of commercially funded births in Oregon from 2012-2017 using an All-Payer All Claims database. Our primary exposure was out-of-pocket spending (deductibles, co-payments, and co-insurance, all health care costs that fall directly on the patient) for the birthing person from the first of the calendar year through delivery discharge. We utilized multivariable log-binomial regression to estimate how out-of-pocket spending impacts readmissions and emergency department visits within one-year postpartum and postpartum visit attendance within 12 weeks. We stratified the final models by pre-term birth status to assess if an out-of-pocket financial burden has a different impact on “higher risk” births.

Results: Among our population of commercial insured birthing people (N=78,147), 28.7% (N=22,406) had out-of-pocket health care costs over $2,500. Compared to births with $0 in out-of-pocket financial burden through delivery discharge, births with over $5,000 were 15% less likely to attend their comprehensive postpartum visit within 12 weeks (RR: 0.85, 95% CI: 0.83, 0.88) and 20% less visit the emergency department (RR: 0.80, 95% CI: 0.73, 0.88). We observed no statistically significant differences between out-of-pocket financial burden and readmissions.

Conclusion: The financial burden of health care may influence care-seeking, including for birthing and postpartum people. As policymakers and clinicians seek solutions to reduce inequities in postpartum health outcomes, the financial burden related to birth should be considered.