title: Early elective deliveries accounted for nearly 9 percent of births paid for by Medicaid.
abstract: Reducing early elective deliveries has become a priority for Medicaid medical directors and their state partners. Such deliveries lead to poor health outcomes for newborns and their mothers and generate additional costs for patients, providers, and Medicaid, which pays for up to 48 percent of all births in the United States each year. Early elective deliveries are non-medically indicated labor inductions or cesarean deliveries of infants with a confirmed gestational age of less than thirty-nine weeks. This retrospective descriptive study reports the results of a perinatal project, led by the state Medicaid medical directors, that sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Twenty-two states participated in the project and provided data on elective deliveries in the period 2010-12. We found that 75,131 (8.9 percent) of 839,688 Medicaid singleton births were early elective deliveries. Thus, we estimate that there are 160,000 early elective Medicaid deliveries nationwide each year. In twelve states, early-term elective deliveries declined 32 percent between 2007 and 2011. Our study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries.
authors.affiliation: Tara Trudnak Fowler (tara.fowler@altarum.org) was a senior research manager at AcademyHealth at the time of this study. She is now a senior researcher at Altarum Institute, in Alexandria, Virginia.
authors.forename: Tara Trudnak
authors.initials: TT
authors.lastname: Fowler
authors.affiliation: Jeff Schiff is Medicaid medical director for Minnesota Health Care Programs in the Health Services and Medical Management Division, Minnesota Department of Human Services, in Saint Paul.
authors.forename: Jeff
authors.initials: J
authors.lastname: Schiff
authors.affiliation: Mary S. Applegate is Medicaid medical director in the Ohio Department of Medicaid, in Columbus.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Applegate
authors.affiliation: Katherine Griffith is a senior manager at AcademyHealth, in Washington, D.C.
authors.forename: Katherine
authors.initials: K
authors.lastname: Griffith
authors.affiliation: Gerry L. Fairbrother is a senior scholar at AcademyHealth.
authors.forename: Gerry L
authors.initials: GL
authors.lastname: Fairbrother
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data*; D008423:Maternal Age; D008484:Medicaid / Q000706:statistics & numerical data*; D011247:Pregnancy; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Maternal And Child Health; Medicaid; Quality Of Care; early elective delivery; perinatal