Tara Trudnak Fowler,1 Gerry Fairbrother,1 Pamela Owens,2 Nicole Garro,3 Cynthia Pellegrini,3 and Lisa Simpson1
1AcademyHealth 2Agency for Healthcare Research and Quality 3March of Dimes
Background: With the steady growth in Medicaid enrollment since the recent recession, concerns have been raised about care for newborns with complications. This paper uses all-payer administrative data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to examine trends from 2002 through 2009 in complicated newborn hospital stays, and explores the relationship between expected sources of payment and reasons for hospitalizations. Methods: Trends in complicated newborn stays, expected sources of payment, costs, and length of stay were examined. A logistic regression was conducted to explore likely payer source for the most prevalent diagnoses in 2009. Results: Complicated births and hospital discharges within 30 days of birth remained relatively constant between 2002 and 2009, but average costs per discharge increased substantially (p<.001 for trend). Most strikingly, over time, the proportion of complicated births billed to Medicaid increased, while the proportion paid by private payers decreased. Among complicated births, the most prevalent diagnoses were preterm birth/low birth weight (23%), respiratory distress (18%), and jaundice (10%). The top two diagnoses (41% of newborns) accounted for 61% of the aggregate cost. For infants with complications, those with Medicaid were more likely to be complicated due to preterm birth/low birth weight and respiratory distress, while those with private insurance were more likely to be complicated due to jaundice. Conclusions: State Medicaid programs are paying for an increasing proportion of births and costly complicated births. Policies to prevent common birth complications have the potential to reduce costs for public programs and improve birth outcomes.