Title of Presentation

Insurance discontinuity during pregnancy: assessing direction and timing of insurance changes within the PROMISE study cohort

Presenter Biography

Anna is a second-year PhD Epidemiology student at the OHSU-PSU School of Public Health. Her research interests include maternal and child health epidemiology with a focus on twin gestations, maternal health disparities, and insurance policy.

Institution

OHSU

Program/Major

Epidemiology

Degree

PhD

Presentation Type

Presentation

Start Date

6-4-2022 1:03 PM

End Date

6-4-2022 1:14 PM

Keywords

insurance discontinuity; insurance churn; perinatal

Abstract

Insurance discontinuity occurs when a person’s health insurance type changes, including uninsurance. This is common perinatally due to relaxed Medicaid eligibility during pregnancy. Self-reported, cross-sectional data document widespread perinatal insurance discontinuity in the US, but definitions of longitudinal patterns relying on contemporaneous data are needed. Our objectives were to define insurance discontinuity patterns and describe the direction (e.g., uninsured to public) and timing of insurance type changes during pregnancy.

Data were from the PROMISE Study on gestational weight gain, which analyzes electronic medical record data from the ADVANCE Research Network. Pregnancies in 2004-2020 with recorded insurance type at conception and delivery and >=3 visits during pregnancy at OCHIN community health centers, which provide care regardless of insurance or ability to pay, were included. Insurance type at each visit was categorized as Public, Private, Uninsured, and Noncomprehensive. Insurance discontinuity was defined as utilization of at least two insurance statuses (e.g., uninsured/public) during pregnancy.

Of 71,176 pregnancies, 29% had insurance discontinuity. Uninsured/public discontinuity was the most common type (20%). Of them, 81% were publicly insured by delivery, indicating transition from uninsurance to public insurance. The first insurance type change occurred at a mean of 18 weeks’ gestation. Insurance type changes occurred earliest among those with at least three insurance types (13 weeks) and latest among those with uninsured/private discontinuity (21 weeks).

A foundation of contemporaneously recorded insurance trajectories will allow us to better understand differing health outcomes and may be used to amend health insurance policies.

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Apr 6th, 1:03 PM Apr 6th, 1:14 PM

Insurance discontinuity during pregnancy: assessing direction and timing of insurance changes within the PROMISE study cohort

Insurance discontinuity occurs when a person’s health insurance type changes, including uninsurance. This is common perinatally due to relaxed Medicaid eligibility during pregnancy. Self-reported, cross-sectional data document widespread perinatal insurance discontinuity in the US, but definitions of longitudinal patterns relying on contemporaneous data are needed. Our objectives were to define insurance discontinuity patterns and describe the direction (e.g., uninsured to public) and timing of insurance type changes during pregnancy.

Data were from the PROMISE Study on gestational weight gain, which analyzes electronic medical record data from the ADVANCE Research Network. Pregnancies in 2004-2020 with recorded insurance type at conception and delivery and >=3 visits during pregnancy at OCHIN community health centers, which provide care regardless of insurance or ability to pay, were included. Insurance type at each visit was categorized as Public, Private, Uninsured, and Noncomprehensive. Insurance discontinuity was defined as utilization of at least two insurance statuses (e.g., uninsured/public) during pregnancy.

Of 71,176 pregnancies, 29% had insurance discontinuity. Uninsured/public discontinuity was the most common type (20%). Of them, 81% were publicly insured by delivery, indicating transition from uninsurance to public insurance. The first insurance type change occurred at a mean of 18 weeks’ gestation. Insurance type changes occurred earliest among those with at least three insurance types (13 weeks) and latest among those with uninsured/private discontinuity (21 weeks).

A foundation of contemporaneously recorded insurance trajectories will allow us to better understand differing health outcomes and may be used to amend health insurance policies.