title: Hospital Utilization and Costs Among Preterm Infants by Payer: Nationwide Inpatient Sample, 2009.
abstract: OBJECTIVE
  To describe hospital utilization and costs associated with preterm or low birth weight births (preterm/LBW) by payer prior to implementation of the Affordable Care Act and to identify areas for improvement in the quality of care received among preterm/LBW infants.
  
  
  METHODS
  Hospital utilization-defined as mean length of stay (LOS, days), secondary diagnoses for birth hospitalizations, primary diagnoses for rehospitalizations, and transfer status-and costs were described among preterm/LBW infants using the 2009 Nationwide Inpatient Sample.
  
  
  RESULTS
  Approximately 9.1 % of included hospitalizations (n = 4,167,900) were births among preterm/LBW infants; however, these birth hospitalizations accounted for 43.4 % of total costs. Rehospitalizations of all infants occurred at a rate of 5.9 % overall, but accounted for 22.6 % of total costs. This pattern was observed across all payer types. The prevalence of rehospitalizations was nearly twice as high among preterm/LBW infants covered by Medicaid (7.6 %) compared to commercially-insured infants (4.3 %). Neonatal transfers were more common among preterm/LBW infants whose deliveries and hospitalizations were covered by Medicaid (7.3 %) versus commercial insurance (6.5 %). Uninsured/self-pay preterm and LBW infants died in-hospital during the first year of life at a rate of 91 per 1000 discharges-nearly three times higher than preterm and LBW infants covered by either Medicaid (37 per 1000) or commercial insurance (32 per 1000).
  
  
  CONCLUSIONS
  When comparing preterm/LBW infants whose births were covered by Medicaid and commercial insurance, there were few differences in length of hospital stays and costs. However, opportunities for improvement within Medicaid and CHIP exist with regard to reducing rehospitalizations and neonatal transfers.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-74, Atlanta, GA, 30341, USA. dbarradas@cdc.gov.
authors.forename: Danielle T
authors.initials: DT
authors.lastname: Barradas
authors.affiliation: Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Wasserman
authors.affiliation: Division of Quality, Evaluation, and Health Outcomes, Children and Adults Health Programs Group, Center for Medicaid and CHIP Services, Center for Medicare and Medicaid Services, Baltimore, MA, USA.
authors.forename: Lekisha
authors.initials: L
authors.lastname: Daniel-Robinson
authors.affiliation: Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
authors.forename: Marino A
authors.initials: MA
authors.lastname: Bruce
authors.affiliation: Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
authors.forename: Katherine Isselmann
authors.initials: KI
authors.lastname: DiSantis
authors.affiliation: Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Navarro
authors.affiliation: Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
authors.forename: Warren A
authors.initials: WA
authors.lastname: Jones
authors.affiliation: Provider Resources, Inc. Healthcare Quality and Disparities Division, Erie, PA, USA.
authors.forename: Nadine M
authors.initials: NM
authors.lastname: Manzi
authors.affiliation: Truven Health Analytics, Ann Arbor, MI, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Smith
authors.affiliation: Truven Health Analytics, Ann Arbor, MI, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Goodness
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D019538:Health Care Surveys; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008484:Medicaid; D058991:Patient Protection and Affordable Care Act; D011247:Pregnancy; D047928:Premature Birth / Q000191:economics* / Q000453:epidemiology; D011787:Quality of Health Care; D014481:United States
keywords: Insurance; Low birth weight; Preterm birth