Having medical insurance during pregnancy and childbirth can affect the chances of adverse
birth outcomes and even infant survival. This is among the conclusions advanced in an
Alabama Department of Public Health publication which analyzes the methods of payment for
delivering babies in Alabama.
The report, "Method of Payment for Delivery," uses data from birth certificates filed with the
Center for Health Statistics. In 2005, 48 percent of Alabama deliveries were paid for by
Medicaid, 48 percent by private insurance, and the remaining 4 percent were either by self pay
or other means.
Birth outcomes varied by method of payment for delivery. For example, babies whose delivery
was paid for by Medicaid were 40 percent more likely to be born at low birth weight as were
those whose deliveries were paid for by private insurance. Babies whose mothers were self pay
were the most likely to be born at low birth weight. Low birth weight is associated with infant
morbidity and mortality.
Infants whose deliveries were self pay were nearly twice as likely to die as those whose
deliveries were paid by Medicaid and over three times as likely to die as those whose deliveries
were covered by private insurance. Babies covered by Medicaid were more than 60 percent
more likely to die than those paid by private insurance.
The report stated, "These outcome differences reflect the different socioeconomic and cultural
risk factors of mothers as well as the amount and quality of health services received by mothers
with different methods of payment for delivery."
Dr. Donald Williamson, state health officer, said, "Finding ways to increase the number of
women with insurance should greatly reduce the number of mothers with late or no prenatal
care and improve pregnancy outcomes by reducing the incidence of low birth weight babies and
infant mortality."
Factors which had a bearing on method of payment for delivery included level of education,
maternal age and marital status.
- The study finds clear differences in insurance coverage by the educational attainment of the
mother. Medicaid coverage and self pay were more prevalent among the poorly educated and
decreased with the level of educational attainment.
- The method of payment for delivery also varied greatly by the mother's age. Medicaid paid for
four of every five births to teenagers. Mothers 20 to 34 years of age had half of their deliveries
paid by private insurance while Medicaid paid for two of every five deliveries. For mothers 35
and older, almost 80 percent were paid for by private insurance, while Medicaid paid for fewer
than one out of five deliveries.
- Being married also affected the method of payment for delivery. More than 80 percent of
deliveries for unmarried mothers were paid for by Medicaid compared to only 29.8 percent of
deliveries to married mothers.
Insurance status affects when women begin receiving prenatal care. Virtually all women with
private health insurance began prenatal care during the first three months of pregnancy. Among
women with Medicaid insurance, only 74.7 percent began prenatal care in the first trimester,
while only 46.8 percent of women without health insurance began prenatal care in the first
trimester.
"Method of Payment for Delivery," a four-page document, is available
here.
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