Allen Heidi, Spishak-Thomas Mandi, Underhill Kristen, Liu Chen, Daw Jamie R
Columbia University School of Social Work.
Rutgers Center for State Health Policy.
Milbank Q. 2024 Dec;102(4):868-895. doi: 10.1111/1468-0009.12721. Epub 2024 Nov 5.
Policy Points This study examines exposure to out-of-pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid-insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum. We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income. We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses.
Out-of-pocket (OOP) costs related to childbirth and postpartum care may cause financial hardship, depending on type of insurance and income.
We estimated OOP spending on childbirth and postpartum care and financial strain 1 year after birth, comparing Medicaid-insured births with commercially insured births. The Postpartum Assessment of Health Survey followed up with respondents to the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System after a 2020 birth in six states and New York City. The survey included questions on health care costs and financial well-being. Our analytic sample consisted of 4,453 postpartum people, 1,544 with a Medicaid-insured birth and 2,909 with a commercially insured birth.
We observe significant financial hardship from childbirth that persists into the postpartum year, with significant differences by insurance and income. We find Medicaid is highly financially protective relative to commercial insurance; 81.4% of Medicaid-insured births were free to the patient, compared with 15.7% of commercially insured births (p < 0.001). Six of ten commercially insured births (59%) cost over $1,000 OOP. Among respondents reporting OOP costs for childbirth, we found that Medicaid enrollees are more likely to have borrowed money from friends or family to pay for childbirth (8% vs. 1%, p < 0.001) and one in five had not made any payments 1 year postpartum (26% vs. 5% of commercially insured births, p < 0.001). Among the commercially insured, those with incomes under 200% of the federal poverty level (FPL) fared worse financially than those above 200% FPL on a number of indicators, including debt in collection (33% vs. 13%, p < 0.001) and financial worry (55% vs. 34%, p < 0.001).
The cost of childbirth and postpartum health care results in significant and persistent financial hardship, particularly for families with lower income with commercial insurance. Medicaid offers greater protection for families with low income by offering reduced cost sharing for childbirth and postpartum health care, but even minimal cost sharing in Medicaid causes financial strain.
政策要点 本研究调查了与医疗补助保险分娩者相比，商业保险分娩者的分娩及产后护理自付费用情况，以及产后12个月的后续财务状况。我们发现，相对于商业保险，医疗补助在分娩和产后护理的医疗费用方面具有很强的保护作用，尤其是对于低收入的分娩者。我们发现，报告有分娩自付费用的医疗补助接受者在产后12个月仍存在持续的医疗债务和担忧。
与分娩和产后护理相关的自付费用可能会导致经济困难，这取决于保险类型和收入情况。
我们估算了分娩和产后护理的自付费用以及产后1年的财务压力，将医疗补助保险分娩与商业保险分娩进行比较。《产后健康评估调查》对2020年在六个州和纽约市分娩的疾病控制与预防中心（CDC）妊娠风险评估监测系统的受访者进行了随访。该调查包括了有关医疗费用和财务状况的问题。我们的分析样本包括4453名产后人员，其中1544名是医疗补助保险分娩者，2909名是商业保险分娩者。
我们观察到分娩带来的重大经济困难持续到产后一年，保险类型和收入存在显著差异。我们发现，相对于商业保险，医疗补助在财务方面具有很强的保护作用；81.4%的医疗补助保险分娩对患者免费，而商业保险分娩的这一比例为15.7%（p < 0.001）。十分之六的商业保险分娩（59%）自付费用超过1000美元。在报告有分娩自付费用的受访者中，我们发现医疗补助参保者更有可能向朋友或家人借钱支付分娩费用（8%对1%，p < 0.001），五分之一的人在产后1年仍未支付任何费用（26%对商业保险分娩者的5%，p < 0.001）。在商业保险参保者中，收入低于联邦贫困线（FPL）200%的人群在多项指标上的财务状况比收入高于FPL 200%的人群更差，包括催收债务（33%对13%，p < 0.001）和财务担忧（55%对34%，p < 0.001）。
分娩和产后医疗保健费用导致了重大且持续的经济困难，特别是对于低收入且有商业保险的家庭。医疗补助通过减少分娩和产后医疗保健的费用分担，为低收入家庭提供了更大的保护，但即使是医疗补助中的最低费用分担也会造成经济压力。
