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Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients

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Abstract

To explore racial-ethnic disparities in adverse pregnancy outcomes among Medicaid recipients, and to estimate excess Medicaid costs associated with the disparities. Cross-sectional study of adverse pregnancy outcomes and Medicaid payments using data from Medicaid Analytic eXtract files on all Medicaid enrollees in fourteen southern states. Compared to other racial and ethnic groups, African American women tended to be younger, more likely to have a Cesarean section, to stay longer in the hospital and to incur higher Medicaid costs. African-American women were also more likely to experience preeclampsia, placental abruption, preterm birth, small birth size for gestational age, and fetal death/stillbirth. Eliminating racial disparities in adverse pregnancy outcomes (not counting infant costs), could generate Medicaid cost savings of $114 to $214 million per year in these 14 states. Despite having the same insurance coverage and meeting the same poverty guidelines for Medicaid eligibility, African American women have a higher rate of adverse pregnancy outcomes than White or Hispanic women. Racial disparities in adverse pregnancy outcomes not only represent potentially preventable human suffering, but also avoidable economic costs. There is a significant financial return-on-investment opportunity tied to eliminating racial disparities in birth outcomes. With the Affordable Care Act expansion of Medicaid coverage for the year 2014, Medicaid could be powerful public health tool for improving pregnancy outcomes.

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Acknowledgments

Financial support for this research was provided by the Agency for Healthcare Research and Quality (AHRQ) grant #1R24HS019470 and by a grant from the Healthcare Georgia Foundation.

Conflict of interest

None of the authors have a conflict of interest.

Author information

Authors and Affiliations

  1. National Center for Primary Care at Morehouse School of Medicine, 720 Westview Drive, NCPC Room 307, Atlanta, GA, 30310, USA

    Shun Zhang, Jiali Ye & George Rust

  2. Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA

    Kathryn Cardarelli

  3. Department of Psychiatry, Morehouse School of Medicine, Atlanta, GA, USA

    Ruth Shim

  4. Division of Maternal-Child Health, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA, USA

    Karla L. Booker

Authors
  1. Shun Zhang
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  2. Kathryn Cardarelli
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  3. Ruth Shim
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  4. Jiali Ye
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  5. Karla L. Booker
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  6. George Rust
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Corresponding author

Correspondence to Shun Zhang.

Additional information

This findings have been accepted as poster presentation at AcademyHealth’s 2012 Annual Research Meeting (ARM), June 24–26 at the Walt Disney World Swan and Dolphin Hotel in Orlando, FL, USA.

Disparities in pregnancy outcomes continue to exist. Interventions that reduce or eliminate these disparities may represent economic return on investment.

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Zhang, S., Cardarelli, K., Shim, R. et al. Racial Disparities in Economic and Clinical Outcomes of Pregnancy Among Medicaid Recipients. Matern Child Health J 17, 1518–1525 (2013). https://doi.org/10.1007/s10995-012-1162-0

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  • DOI: https://doi.org/10.1007/s10995-012-1162-0

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