Medicaid Coverage and Medical Interventions During Pregnancy

Abstract

This paper extends prior research on the effect of Medicaid coverage on medical interventions during pregnancy (prenatal ultrasound) and birth (ultrasound during delivery, cesarean delivery, inducement, and fetal monitor). The data are from two sources: the New York State Vital Statistics (VS) matched infant birth-death file and the Statewide Planning and Research Cooperative System (SPARCS) file for 1993--1996. Medicaid coverage increases the likelihood of teens and adults receiving prenatal care relative to being uninsured. Overall, the effect of insurance type varies depending on whether the procedure is part of standard care (ultrasound and fetal monitor) or more likely to be elective (inducement and cesarean delivery). Insurance type has a greater effect for elective procedures than for procedures that are part of standard care.

Trends in mode of delivery during 1984–2003: can they be explained by pregnancy and delivery complications?

“…Recent decades have seen major changes in mode of delivery in developed countries, with rates of caesarean section rising from 5% in the 1970s 1–5 to more than 50% in some countries in the late 1990s 6 . Multiple factors are thought to have contributed to the rise in caesarean section rates including demographic and nutritional factors, 7 increasing rates of induction of labour, 8 increasing use of electronic fetal heart rate monitoring, 9 provider and patient perception of the safety of caesarean section versus the risks associated with instrumental vaginal delivery, 10 defensive obstetric practice, 11 and patient demand 12,13 …”

“…6 Multiple factors are thought to have contributed to the rise in caesarean section rates including demographic and nutritional factors, 7 increasing rates of induction of labour, 8 increasing use of electronic fetal heart rate monitoring, 9 provider and patient perception of the safety of caesarean section versus the risks associated with instrumental vaginal delivery, 10 defensive obstetric practice, 11 and patient demand. 12,13 Although there have been improvements in surgical and anaesthetic techniques for caesarean section over the past 30 years (resulting in a reduced risk of postoperative complications), caesarean section is still associated with an increased risk of maternal death when compared with vaginal deliveries. 14 Data from the 2000-03 Report of Confidential Enquiries into Maternal Deaths in the UK reported a relative risk of maternal death for caesarean section compared with vaginal deliveries of 2.8 (95% CI 1.9-4.4), 15 somewhat higher than the previously reported risk for 1997-99 of 2.2 (95% CI 1.5-3.1).…”

Outcomes of Planned Home Birth: An Integrative Review

“…The incidence of caesarean section has risen in the United States and in other developed and developing countries 78,79 . The increase has been attributed to increasing demand for elective caesarean birth 80,81 and changes in financial access to this service 82,83 . These higher cesarean section rates have been associated with an increase in maternal 84 and fetal mortality rates and a higher rate of admission to neonatal intensive care units 85 .…”

Modelos de assistência ao parto e taxa de cesárea em diferentes países

“…These actors and stakeholders, including physicians, patients and insurers (health insurance for patients and professional liability insurance for physicians for medical malpractice), hospitals and the government, through health policies, determine the utilization of medical procedures, and there is a need to identify the each actor/stakeholder's motivation and its effect on utilization. 41 In the private health care system, some issues characteristic of metropolitan areas and large urban cities of Brazil have made the doctor-patient relationship more complex and confl icted with health insurance companies mediating the contractual relationship between client and doctor, greater involvement of civil society through movements toward empowerment and human rights advocacy and greater access of clients to information.…”