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ABSTRACT: Adverse maternal and infant health outcomes due to maternal smoking are well known. Previous estimates of health care costs for infants at delivery attributable to maternal smoking were $366 million, $704 per smoker, in 1996 dollars. Changes in antenatal and neonatal care, medical care inflation, and declines in the prevalence of maternal smoking call for an updated analysis.
We used Pregnancy Risk Assessment Monitoring System for 2001/2002 to estimate the association of maternal smoking to Neonatal Intensive Care Unit (NICU) admission and, in turn, the length of stay for infants admitted/not admitted. Models are then used with 2003 natality files to derive predicted expenses as is and "as if" mothers did not smoke. The difference in these predicted expenses is smoking attributable expenses (SAEs). The updated analysis incorporated Hispanic ethnicity as an additional variable, data from 27 as opposed to 13 states, and updated (2004) NICU costs per night.
In contrast to earlier work, we find no significant association of maternal smoking and NICU admission but rather, a positive effect on the length of stay of exposed infants once admitted to the NICU. SAEs were estimated at $122 million (CI = -$29m to $285m) nationally and $279 (CI = -$76 to $653) per maternal smoker in 2004 dollars. Conclusions: Declines in maternal smoking prevalence between the mid-1990s and 2003 combined with a weaker relationship of maternal smoking to NICU admission offset medical care inflation such that infants' SAEs declined. Yet, these are significant in magnitude, incurred immediately and highly preventable.
Nicotine & Tobacco Research 08/2011; 13(8):627-37. · 2.58 Impact Factor
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ABSTRACT: BACKGROUND:Implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allowed states to extend Medicaid to any woman aged <65 without insurance screened and found to need treatment either for breast or cervical cancer or for a precancerous cervical condition through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or in Georgia, other provider sites.METHODS:The authors used linked Georgia Comprehensive Cancer Registry (GCCR) and Medicaid data to test the: 1) likelihood of Medicaid enrollment in a given month and 2) time-to-enrollment (months) for those eventually enrolling. The authors used difference-in-differences analysis to estimate the effects of BCCPTA for breast or cervical cancer cases relative to a control group of women with other cancers. The authors controlled for sociodemographics, stage at diagnosis, year of diagnosis, and county level factors related to insurance levels in the area.RESULTS:Compared with the control cancer group, the hazard ratio of Medicaid enrollment for women with breast and cervical cancers increased post- vs pre-BCCPTA implementation. The estimated effect of this increase was that out of every 1000 women with breast cancer, BCCPTA led to 1.7 more (from 2.8 to 4.5 per month) enrolling in Medicaid. The results for women with local or later stages of cervical cancer indicated that of 1000 women with these cancers, the number enrolling in a given month increased by 3.4 due to BCCPTA. Results on time-to-enrollment indicated that the time between cancer diagnosis and enrollment was shortened by 7 to 8 months.CONCLUSIONS:The Georgia Medicaid program, in response to national legislation, increased the probability of women enrolling in Medicaid earlier and in turn, likely increased their cancer treatment options. Cancer 2009. © 2009 American Cancer Society.
Cancer 03/2009; 115(6):1300 - 1309. · 4.77 Impact Factor
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ABSTRACT: Implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000 (BCCPTA) allowed states to extend Medicaid to any woman aged <65 without insurance screened and found to need treatment either for breast or cervical cancer or for a precancerous cervical condition through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or in Georgia, other provider sites.
The authors used linked Georgia Comprehensive Cancer Registry (GCCR) and Medicaid data to test the: 1) likelihood of Medicaid enrollment in a given month and 2) time-to-enrollment (months) for those eventually enrolling. The authors used difference-in-differences analysis to estimate the effects of BCCPTA for breast or cervical cancer cases relative to a control group of women with other cancers. The authors controlled for sociodemographics, stage at diagnosis, year of diagnosis, and county level factors related to insurance levels in the area.
Compared with the control cancer group, the hazard ratio of Medicaid enrollment for women with breast and cervical cancers increased post- vs pre-BCCPTA implementation. The estimated effect of this increase was that out of every 1000 women with breast cancer, BCCPTA led to 1.7 more (from 2.8 to 4.5 per month) enrolling in Medicaid. The results for women with local or later stages of cervical cancer indicated that of 1000 women with these cancers, the number enrolling in a given month increased by 3.4 due to BCCPTA. Results on time-to-enrollment indicated that the time between cancer diagnosis and enrollment was shortened by 7 to 8 months.
The Georgia Medicaid program, in response to national legislation, increased the probability of women enrolling in Medicaid earlier and in turn, likely increased their cancer treatment options.
Cancer 02/2009; 115(6):1300-9. · 4.77 Impact Factor
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ABSTRACT: More information is needed on the use and costs of public services by teens after the passage of major national polices in the 1990s. Both the 1996 welfare reform and later changes to the Medicaid program have affected the access of low-income adolescents to public assistance programs. In turn, these changes have affected teenaged mothers and their infants and the costs that taxpayers incur in the 50 states.
What public services do teenage mothers use and what are their costs in the decade after the major policy changes to public assistance programs? How do patterns vary by state?
This study examines the use by teenage mothers of four public services: cash assistance, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), food stamps, and Medicaid coverage at delivery. We used 2000 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to derive rates of use for these four programs in ten states-AK, AL, FL, ME, NY [excluding New York City], NC, OK, SC, WA, and WV. We combined the rates with data on per person and family costs of these four programs to present 'birth-year' costs for a cohort of teenage mothers in the ten states. To provide a baseline from which to measure incremental public service costs to teenage mothers, we also compiled the data for mothers ages 20 to 24 years who did not report births during their teen years.
Data from the ten states indicate that the birth-year expenses for teenage mothers for four public programs add up to more than $0.5 billion, and the costs per teenage mother exceed those for older mothers who did not have a teenage birth by almost $1,500. The largest component of these public costs is Medicaid coverage at delivery at 87 percent of the total. If all of the unintended births to teenage mothers in the ten study states were postponed, $75 million in public sector costs would be averted annually.
The use of public programs by teenage mothers remains costly and varies markedly across the ten study states. A key reason for higher costs among teenage mothers than among mothers in their early twenties is their higher rates of enrollment in Medicaid at delivery. This rate of enrollment also varies markedly across the study states. The high level of incremental costs and rate of unintended births to teens indicate that cost-saving interventions could be developed. PUBLIC HEALTH IMPLICATIONS: Data indicate that many teenage pregnancies are unintended. Thus, a clear public health goal should be to implement and evaluate programs aimed at reducing unintended pregnancies among teenagers. Initiatives are needed to help young women make well-informed decisions about sexual activity and other risky behaviors. Insurance coverage is important to all teens and especially to those who are sexually active.
Journal of health care finance 01/2009; 35(3):44-58.
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ABSTRACT: The 1997 State Children's Health Insurance Program (SCHIP) program allowed states to expand Medicaid to uninsured children through age 18 in families under 200% of the federal poverty level. Prepregnancy insurance coverage of adolescents may help reduce unintended pregnancies, address other medical issues, and allow for early and adequate prenatal care for those carrying to term.
We tested the effects of SCHIP implementation on insurance coverage for teenage mothers and investigated whether these effects varied by type of state SCHIP program--Medicaid expansion, stand-alone program, or some combination of these.
We used Pregnancy Risk Assessment Monitoring System data from 1996 through 2000 and difference-in-differences analysis to analyze coverage changes for teenage mothers (age <20) relative to those for mothers aged 20-24 years old, a group whose Medicaid eligibility was not affected by SCHIP policies.
Our raw sample of teenage and older mothers in Alaska, Oklahoma, South Carolina, Florida, Maine, New York, and West Virginia equaled 23,171 (811,638 weighted).
SCHIP implementation was associated with an almost 10 percentage point increase in prepregnancy coverage among teens under age 17. Although there were increases in both public and private coverage only the latter was statistically significant. The only statistically significant increase in Medicaid coverage, equal to almost 16 percentage points, was among 18-year-olds in states with Medicaid expansion programs.
The temporary extension of SCHIP allows time to consider how to maintain the program's potentially positive effect on the reproductive health of adolescents.
Medical care 11/2008; 46(10):1071-8. · 3.24 Impact Factor
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ABSTRACT: This study investigates the impact of welfare reform on insurance coverage before pregnancy and on first-trimester initiation of prenatal care (PNC) among pregnant women eligible for Medicaid under welfare-related eligibility criteria.
We used pooled data from the Pregnancy Risk Assessment Monitoring System for eight states (AL, FL, ME, NY, OK, SC, WA, and WV) from 1996 through 1999.
We estimated a two-part logistic model of insurance coverage before pregnancy and first-trimester PNC initiation. The impact of welfare reform on insurance coverage before pregnancy was measured by marginal effects computed from coefficients of an interaction term for the postreform period and welfare-related eligibility and on PNC initiation by the same interaction term and the coefficients of insurance coverage adjusted for potential simultaneous equation bias. We compared the estimates from this model with results from simple logistic, ordinary least squares, and two-stage least squares models.
Welfare reform had a significant negative impact on Medicaid coverage before pregnancy among welfare-related Medicaid eligibles. This drop resulted in a small decline in their first-trimester PNC initiation. Enrollment in Medicaid before pregnancy was independent of the decision to initiate PNC, and estimates of the effect of a reduction in Medicaid coverage before pregnancy on PNC initiation were consistent over the single- and two-stage models. Effects of private coverage were mixed. Welfare reform had no impact on first-trimester PNC beyond that from reduced Medicaid coverage in the pooled regression but separate state-specific regressions suggest additional effects from time and income constraints induced by welfare reform may have occurred in some states.
Welfare reform had significant adverse effects on insurance coverage and first-trimester PNC initiation among our nation's poorest women of childbearing age. Improved outreach and insurance options for these women are needed to meet national health goals.
Health Services Research 09/2007; 42(4):1564-88. · 2.16 Impact Factor
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ABSTRACT: Actuarial split-sample method were used to assess predictive accuracy of adjusted clinical groups (ACGs) for Medicaid enrollees in Georgia, Mississippi (lagging in managed care penetration), and California. Accuracy for two non-random groups--high-cost and located in urban poor areas--was assessed. Measures for random groups were derived with and without short-term enrollees to assess the effect of turnover on predictive accuracy. ACGs improved predictive accuracy for high-cost conditions in all States, but did so only for those in Georgia's poorest urban areas. Higher and more unpredictable expenses of short-term enrollees moderated the predictive power of ACGs. This limitation was significant in Mississippi due in part, to that State's very high proportion of short-term enrollees.
Health care financing review 02/2002; 24(1):43-61. · 2.06 Impact Factor
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ABSTRACT: Efforts to extend coverage to pregnant women, along with an expanding economy, did not prevent increases in the uninsured in the latter 1990s. Welfare reform may have led to declining Medicaid enrollments and caseloads. Data representative of live births in nine states show that in some states more than one-third of all pregnant women and almost two-thirds of low-income pregnant women lacked insurance before their pregnancy in 1996 and 1999. More than one-third of all pregnant women made some change in coverage by the time they delivered their baby. Among low-income women, the largest change was from uninsured status before pregnancy to Medicaid at delivery.
Health Affairs 22(1):219-29. · 4.31 Impact Factor
