Insurance Impacts Infant Health

Insurance is needed for access; access is vital to life.

Mortality rates associated with premature births in the United States have been a longstanding concern among pediatricians.  Although extensive research and preventative measures have been employed to combat this problem, the US still has one of the largest rates of premature infant mortality compared to other developed countries.  One postulated reason for the nation’s high rates of premature infant mortality is the lack of prenatal and postnatal care.  This study analyzes the contribution of health insurance to survival outcomes for premature newborns.

The study used the Kids’ Inpatient Databases to obtain a sample of discharges from 3,739 community non-rehabilitation hospitals in 38 states. The database includes admissions occurring in the first 28 days of life. The main outcomes of interest were: death during hospitalization and transfer from the hospital of birth or from home to the discharging hospital.  Insurance status was de?ned as uninsured, Medicare, Medicaid, or private.

Uninsured patients comprised 5.4% of the estimated 4,318,216 neonatal discharges and 9.5% of the estimated 17,892 neonatal deaths.  As compared to insured discharges, uninsured discharges occurred more often in the South (47.2% vs. 37.3%, p<0.0001) and among families that resided in rural counties without an urban cluster >10,000 residents (7.7% vs. 5.3%, p<0.0001).

Uninsured neonates were 2.6 (95% CI: 2.4, 2.8) times as likely to die compared to those with private insurance, Medicaid, or Medicare.  Uninsured status was a greater predictor of death for neonatal patients compared to sepsis, obstetrical conditions and complications, respiratory distress syndrome, or multiple birth.

Evaluation of resources allocated to neonatal patients showed that fewer procedures were performed on uninsured neonatal patients (0.92 vs. 0.75, p<0.001). The adjusted length of stay was shorter for uninsured neonates (2.7 vs. 3.7 days, p<0.001) and especially for those who died during hospitalization (2.2 vs. 11.6 days, p<0.001).  Among patients who died, the adjusted mean hospital charge was $58,199 lower for uninsured neonates (p<0.001).

Commentary

It is not surprising that mortality rates were increased for uninsured patients.  As a primary care pediatrician who trained in an underserved population, I have first-hand experience treating premature infants from uninsured families.  Besides limited postnatal resources, these infants were also often affected by lack of prenatal care. Issues related to lack of prenatal care such as unidentified infections, congenital abnormalities, or abnormal  fetal development cause issues that increase the chance of mortality in these infants.

As the study showed, uninsured neonates were not as frequently transferred from rural hospitals to tertiary neonatal medical centers with adequate resources tto improve morbidity and mortality outcomes for these infants.

The recent passage of the Affordable Care Act expands the availability of health insurance to pregnant mothers and their infants. This should decrease the mortality rates of premature infants.  The pediatric medical community collectively recognizes prevention of premature birth as a way to decrease infant mortality rates. Improving access to health care by providing health insurance to both mother and child is one of the first steps needed to effect positive change.

Morriss, FH. HSR. 2013; epub ahead of print.

by

Tyree Winters, DO