title: Trends in hospital-based childbirth care: the role of health insurance.
abstract: OBJECTIVE
  Childbirth is the leading reason for hospitalization in the United States, and maternity related expenditures are substantial for many health insurance programs, including Medicaid. We studied the relationship between primary payer and trends in hospital-based childbirth care.
  
  
  METHODS
  Retrospective analysis of hospital discharge data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project, a 20% stratified sample of US hospitals.
  
  
  METHODS
  Data on 6,717,486 hospital-based births for the years 2002 through 2009 came from the NIS. We used generalized estimating equations to measure associations over time between primary payer (Medicaid, private insurance, or self) and cesarean delivery, vaginal birth after cesarean (VBAC), labor induction, and episiotomy.
  
  
  RESULTS
  Controlling for clinical, demographic, and hospital factors, births covered by Medicaid had lower odds of cesarean delivery (adjusted odds ratio [AOR], 0.91), labor induction (AOR, 0.73), and episiotomy (AOR, 0.62) and higher odds of VBAC (AOR, 1.20; P <.001 for all AORs) compared with privately insured births. Cesarean rates increased 6% annually among births paid by private insurance (AOR, 1.06; P <.001) and less rapidly (5% annually) among those covered by Medicaid.
  
  
  CONCLUSIONS
  US hospital-based births covered by private insurance were associated with higher rates of obstetric intervention than births paid for by Medicaid. After controlling for clinical, demographic, and hospital factors, cesarean delivery rates increased more rapidly among births covered by private insurance, compared with Medicaid. Changes in insurance coverage associated with healthcare reform may impact costs and quality of care for women giving birth in US hospitals.
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA. kbk@umn.edu
authors.forename: Katy B
authors.initials: KB
authors.lastname: Kozhimannil
authors.forename: Tetyana P
authors.initials: TP
authors.lastname: Shippee
authors.forename: Olusola
authors.initials: O
authors.lastname: Adegoke
authors.forename: Beth A
authors.initials: BA
authors.lastname: Vemig
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000191:economics* / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics*; D036801:Parturition; D011247:Pregnancy; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult