Examining the Association between Medicaid Coverage and Preterm Births Using 2010-2013 National Vital Statistics Birth Data

While the rate of preterm birth has declined for the past six consecutive years, it remains a significant public health problem, affecting over 450,000 infants annually.  An Institute of Medicine report documents the causes and consequences of preterm births and estimates a societal burden of $26 billion annually.  Little is known about the burden of preterm birth among insured women with various types of insurance.  This study aimed to 1) determine the association between payer source and preterm births and 2) follow this relationship over a four-year period.

We conducted bivariate statistics and multivariate logistic regression on 2010-2013 National Vital Statistics Birth Data, controlling for known covariates available in the dataset, to evaluate the association between Medicaid coverage and preterm and to determine the strength of this association relative to private payer coverage.

Medicaid covers a lower number/percentage of all births than private insurance, but disproportionately covers preterm births, a statistically significant difference that holds over time.  In 2013, a higher percentage of all births Medicaid covered were preterm compared to private insurance (12.7% vs. 10.9%).  Among all preterm births, Medicaid covered a higher proportion than private insurance (48.9% vs. 42.3%).  Medicaid was 7.5% more likely to pay for a preterm birth than a full term birth, compared to private insurance and controlling for other relevant covariates. 

Effective interventions targeting pregnancy spacing, access to prenatal care, smoking cessation, and healthy weight exist and Medicaid should implement those more widely to improve birth outcomes and achieve substantial cost savings.