TY - JOUR
T1 - Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy
AU - Snowden, Jonathan M.
AU - Osmundson, Sarah S.
AU - Kaufman, Menolly
AU - Blauer Peterson, Cori
AU - Kozhimannil, Katy Backes
N1 - Publisher Copyright:
© Health Research and Educational Trust
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Objective: To test whether Minnesota's blended payment policy had differential effects on cesarean use and maternal morbidity among black women and white women in Minnesota, as compared to six control states. Data sources/study setting: Claims data from births to Medicaid fee-for-service beneficiaries, 2006-2012, in Minnesota (policy state) and six control states (Wisconsin, Iowa, Illinois, Oregon, Idaho, and Montana). Study design: The key study intervention was Minnesota's blended payment policy, which established one single payment rate for uncomplicated vaginal and cesarean births in 2009. The primary outcome was cesarean birth, and secondary outcomes were maternal morbidity (composite), postpartum hemorrhage, and chorioamnionitis. Policy effects were assessed using race-stratified comparative interrupted time series analysis. Principal findings: Following policy implementation, cesarean use decreased among both black and white women in Minnesota compared to control states; this decline was larger among black women (−2.88 percent 3-year cumulative decline, from a prepolicy cesarean rate of 22.2 percent) than among white women (−1.32 percent, P =.0013). Postpartum hemorrhage increased, with larger increases among black women (1.20 percent 3-year cumulative increase), compared with white women (0.48 percent, P '.001) in Minnesota compared with control states. Conclusions: Policy-related declines in cesarean use after Minnesota's blended payment policy were larger in black women. Increases in postpartum hemorrhage signal potential unintended consequences of policy-related cesarean reduction.
AB - Objective: To test whether Minnesota's blended payment policy had differential effects on cesarean use and maternal morbidity among black women and white women in Minnesota, as compared to six control states. Data sources/study setting: Claims data from births to Medicaid fee-for-service beneficiaries, 2006-2012, in Minnesota (policy state) and six control states (Wisconsin, Iowa, Illinois, Oregon, Idaho, and Montana). Study design: The key study intervention was Minnesota's blended payment policy, which established one single payment rate for uncomplicated vaginal and cesarean births in 2009. The primary outcome was cesarean birth, and secondary outcomes were maternal morbidity (composite), postpartum hemorrhage, and chorioamnionitis. Policy effects were assessed using race-stratified comparative interrupted time series analysis. Principal findings: Following policy implementation, cesarean use decreased among both black and white women in Minnesota compared to control states; this decline was larger among black women (−2.88 percent 3-year cumulative decline, from a prepolicy cesarean rate of 22.2 percent) than among white women (−1.32 percent, P =.0013). Postpartum hemorrhage increased, with larger increases among black women (1.20 percent 3-year cumulative increase), compared with white women (0.48 percent, P '.001) in Minnesota compared with control states. Conclusions: Policy-related declines in cesarean use after Minnesota's blended payment policy were larger in black women. Increases in postpartum hemorrhage signal potential unintended consequences of policy-related cesarean reduction.
KW - cesarean birth
KW - health policy
KW - maternal outcomes
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U2 - 10.1111/1475-6773.13319
DO - 10.1111/1475-6773.13319
M3 - Article
C2 - 32677043
AN - SCOPUS:85088153800
SN - 0017-9124
VL - 55
SP - 729
EP - 740
JO - Health Services Research
JF - Health Services Research
IS - 5
ER -