title: Trends in complicated newborn hospital stays & costs, 2002-2009: implications for the future.
abstract: BACKGROUND
  With the steady growth in Medicaid enrollment since the recent recession, concerns have been raised about care for newborns with complications. This paper uses all-payer administrative data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to examine trends from 2002 through 2009 in complicated newborn hospital stays, and explores the relationship between expected sources of payment and reasons for hospitalizations.
  
  
  METHODS
  Trends in complicated newborn stays, expected sources of payment, costs, and length of stay were examined. A logistic regression was conducted to explore likely payer source for the most prevalent diagnoses in 2009.
  
  
  RESULTS
  Complicated births and hospital discharges within 30 days of birth remained relatively constant between 2002 and 2009, but average costs per discharge increased substantially (p<.001 for trend). Most strikingly, over time, the proportion of complicated births billed to Medicaid increased, while the proportion paid by private payers decreased. Among complicated births, the most prevalent diagnoses were preterm birth/low birth weight (23%), respiratory distress (18%), and jaundice (10%). The top two diagnoses (41% of newborns) accounted for 61% of the aggregate cost. For infants with complications, those with Medicaid were more likely to be complicated due to preterm birth/low birth weight and respiratory distress, while those with private insurance were more likely to be complicated due to jaundice.
  
  
  CONCLUSIONS
  State Medicaid programs are paying for an increasing proportion of births and costly complicated births. Policies to prevent common birth complications have the potential to reduce costs for public programs and improve birth outcomes.
authors.affiliation: AcademyHealth.
authors.forename: Tara
authors.initials: T
authors.lastname: Trudnak Fowler
authors.affiliation: AcademyHealth.
authors.forename: Gerry
authors.initials: G
authors.lastname: Fairbrother
authors.affiliation: Agency for Healthcare Research and Quality.
authors.forename: Pamela
authors.initials: P
authors.lastname: Owens
authors.affiliation: March of Dimes.
authors.forename: Nicole
authors.initials: N
authors.lastname: Garro
authors.affiliation: March of Dimes.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pellegrini
authors.affiliation: AcademyHealth.
authors.forename: Lisa
authors.initials: L
authors.lastname: Simpson
mesh_terms: D005544:Forecasting; D017721:Hospital Costs / Q000706:statistics & numerical data* / Q000639:trends; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000191:economics* / Q000453:epidemiology; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: HCUP; Medicaid; complicated births; low birth weight; newborns; preterm birth