For a study, researchers sought to describe the prevalence, trends, and risk factors for catastrophic health expenditures among birth parents in the year after delivery (delivering people). From 2008 to 2016, they performed a retrospective, cross-sectional analysis of the Medical Expenditure Panel Survey. They identified baby birth parents and a 2:1 nearest-neighbor propensity-matched control cohort of nonpregnant reproductive-aged persons and then assessed for catastrophic health expenditures (spending more than 10% of family income) throughout the delivery year. To extrapolate to the noninstitutionalized U.S. population, they employed survey weights and the modified Wald test for significance testing. They evaluated the likelihood of catastrophic health expenditures between birth parents and the control cohort, as well as temporal trends and risk variables for catastrophic spending using subgroup comparisons.
In a given year, they looked at 4,056 birth parents and 7,996 reproductive-aged females who were not pregnant. Birth parents reported greater rates of unemployment (52.6 vs 46.6 %, P<.001), as well as high rates of acquiring (22.4%) and losing (25.6%) Medicaid during the delivery year. Birth parents were more likely to incur catastrophic health expenses (without premiums: 9.2% versus 6.8%, odds ratio [OR] 1.95, 95% CI 1.61–2.34; including premiums: 21.3% vs 18.4%, OR 1.53, 95% CI 1.32–1.82). Birth parents with modest incomes were at the greatest risk of incurring catastrophic health-care costs (18.8% vs 0.7% excluding premiums for 138% or less vs greater than 400% of the federal poverty level, relative risk [RR] 26.9; 29.8% vs 5.9% including premiums, RR 5.1). For low-income birth parents, public insurance was associated with lower risks of catastrophic health expenditures than private insurance, especially when premium spending was considered (incomes 138% or lower: 18.8% public vs 67.9% private, RR 0.28; incomes 139–250 % of the federal poverty level: 6.5% public vs 41.1% private, RR 0.16). From prior to after the establishment of the Affordable Care Act, the probability of catastrophic spending for birth parents did not vary considerably.
Pregnancy and delivery were linked to an elevated risk of catastrophic health expenditures in the year of delivery. Medicaid and public coverage provided more protection against high out-of-pocket expenditures than private insurance, particularly among low-income families.
