title: Maternal health insurance coverage as a determinant of obstetrical anesthesia care.
abstract: This study measures the association between health insurance and the likelihood of receiving different obstetrical anesthesia protocols among 121,351 singleton live births in upstate New York during 1992. Mothers receiving a cesarean under Medicaid were approximately twice as likely to receive general anesthesia as those with traditional private coverage. Those receiving a cesarean under an HMO were least likely to receive general anesthesia with adjusted odds of 0.73 (confidence interval [CI] = 0.68-0.79), compared to those with traditional private insurance. Those delivering vaginally under Medicaid, HMO, or no coverage had adjusted odds of receiving an epidural of 0.45 (CI = 0.43-0.48), 0.68 (CI = 0.64-0.71), and 0.44 (CI = 0.38-0.52), respectively, compared to those under traditional private insurance. Although there was some differences by race, the strongest determinant of anesthesia remained insurance type. Insurance-mediated disparities in obstetrical anesthesia care are evident in upstate New York and warrant further study nationally.
authors.affiliation: State University of New York at Buffalo, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Obst
authors.forename: E
authors.initials: E
authors.lastname: Nauenberg
authors.forename: G M
authors.initials: GM
authors.lastname: Buck
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000191:economics* / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000191:economics / Q000379:methods; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000191:economics* / Q000379:methods; D005260:Female; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000145:classification*; D007348:Insurance, Health; D016013:Likelihood Functions; D008484:Medicaid; D009518:New York; D011247:Pregnancy; D014481:United States