How Insurance and Location Affect Severe Pregnancy Complications

The link between severe maternal morbidity (SMM) and various factors is well-documented. These factors include the mother's background, the hospital where she delivers, and where she lives. However, the role these factors play in racial disparities within different insurance groups is not well understood. The focus is on Georgia, where data from 2016 to 2020 was analyzed. This data included vital records and hospital discharge information for both Medicaid and privately insured mothers. The goal was to identify cases of SMM during delivery or within 42 days postpartum. The findings reveal that Medicaid-insured mothers face a higher rate of SMM compared to those with private insurance. Surprisingly, the gap in SMM rates between Black and White mothers is smaller within the Medicaid group than among the privately insured. This suggests that Medicaid might be playing a role in reducing racial disparities in severe pregnancy complications. However, the reasons behind this are complex and multifaceted. Researchers used a method called Oaxaca-Blinder decomposition to break down the Black-White SMM gap. This method helps to understand how much of the gap can be explained by different factors. When hospital-specific effects were included, the explained portion of the gap increased significantly. For Medicaid-insured mothers, the explained gap rose by 29. 1 percentage points. For privately insured mothers, it increased by 9. 4 percentage points. This indicates that hospital practices and policies have a substantial impact on racial disparities in SMM. Residential factors, such as where a mother lives, also play a crucial role. For Medicaid-insured mothers, these factors significantly reduced the explained gap in SMM rates between Black and White mothers. However, for privately insured mothers, residential factors had little to no impact. This raises questions about access to healthcare providers and the quality of care in different areas. Areas with better provider access tend to reduce the gap among Medicaid-insured mothers, highlighting the importance of healthcare infrastructure. The analysis shows that differences in how hospitals treat patients of different races contribute significantly to the SMM gap. This is particularly true within the same hospital. Additionally, living in areas with better healthcare access seems to help reduce the gap among Medicaid-insured mothers. This suggests that improving hospital practices and increasing access to healthcare providers could help address racial disparities in severe pregnancy complications.