Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy
Cesarean Delivery Rates and Costs of Childbirth in a State Medicaid Program After Implementation of a Blended Payment Policy
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DOI：
10.1097/mlr.0000000000000937
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发表时间：
2018-08-01
期刊：
影响因子：
3
通讯作者：
Snowden, Jonathan M.
中科院分区：
文献类型：
--
作者：
Kozhimannil, Katy B.;Graves, Amy J.;Snowden, Jonathan M.
背景：近一半的美国分娩是由医疗补助资助的，三分之一的分娩是剖腹产，成本是阴道分娩的两倍。随着减少不必要的剖宫产使用和提高价值的目标，在2009年明尼苏达州的医疗补助计划介绍了一个混合支付率为无并发症的分娩（即，一个单一的设施或专业服务支付，无论分娩模式）。Objective：我们评估了混合支付政策对剖宫产使用和医疗补助费为服务births.Methods成本的影响：我们确定了出生在医疗补助分析提取文件从3年前和2009年支付变化后，在明尼苏达州和6个控制状态。我们使用了一个季度中断的时间序列方法来评估政策相关的研究结果的变化，比较明尼苏达州的控制状态。结果包括剖腹产，分娩住院费用，孕产妇发病率。结果：明尼苏达州的prepolicy剖宫产率（22.8%）下降了0.27个百分点，每季度的政策后，总下降了3.24个百分点，与控制状态（P=0.01）。明尼苏达州的分娩住院费用在政策实施时下降了425.80美元。政策后，明尼苏达州的分娩住院费用继续下降，与政策前相比，每季度下降95.04美元，下降幅度大于对照州（P
Background:Nearly half of US births are financed by Medicaid, and one-third of births occur by cesarean delivery, at double the cost of vaginal delivery. With the goal of reducing unnecessary cesarean use and improving value, in 2009 Minnesota's Medicaid program introduced a blended payment rate for uncomplicated births (ie, a single facility or professional services payment regardless of delivery mode).Objective:We evaluated the effect of the blended payment policy on cesarean use and costs for Medicaid fee-for-service births.Methods:We identified births in Medicaid Analytic Extract files from 3 years before and after the 2009 payment change in Minnesota and in 6 control states. We used a quarterly interrupted time series approach to assess policy-related changes in study outcomes, comparing Minnesota to control states. Outcomes included cesarean delivery, childbirth hospitalization costs, and maternal morbidity.Results:Minnesota's prepolicy cesarean rate (22.8%) decreased 0.27 percentage points per quarter after the policy for a total decrease of 3.24 percentage points, compared with control states (P=0.01). The cost of childbirth hospitalizations in Minnesota dropped by $425.80 at the time of the policy. Postpolicy, childbirth hospitalization costs continued to decrease in Minnesota relative to prepolicy by $95.04 per quarter, and declined more than control states (P