Abstract and Introduction
Abstract
Recent health care legislative acts, federal budget cuts, and changes in health care reimbursement are posing significant challenges for mothers accessing health care for their infants. There is very little reported literature on post-birth newborn morbidity and associated charges for full-term infants within the first two months of life, a time of increased risk for mortality.
Purpose. To examine infant morbidities, associated health care charges, and access to health care within the first eight weeks in healthy, full-term infants born to low-income, first-time mothers.
Design. A secondary analysis of data from a randomized clinical trial that compared infants' health and newborn health care charges.
Methods. Data on infant morbidity and health care charges on 139 first-time mothers and their healthy full-term newborns were collected at one and two months post-hospital discharge. Data were analyzed using descriptive statistics and two-sample t-tests.
Findings. The most common infant morbidity was upper respiratory illness. Morbidities occurred as early as day two post-hospital discharge. Total charges were emergency room visits – $24,255, urgent care visits – $2,937, and rehospitalizations – $56,377. Most newborns received a well-baby clinic visit within 48 to 72 hours post-hospital discharge.
Conclusion. Studies of morbidities, health care charges, and access to care for infants two months and less are very limited. However, such data are important because of increasing health care costs, health care budget cuts, and the lack of an infant morbidity surveillance system.
Introduction
There are over four million births annually in the U.S. (Hamilton, Martin, & Ventura, 2010), most of them healthy, full-term newborns. Mothers with full-term infants experience early postpartum hospital discharge and little to no routine additional support following hospital discharge (Brown, Small, Argus, Davis, & Krastev, 2009; Fink, 2011; Kotwal & Anodiyil, 2008).
Recent legislative acts and changes in health care reimbursement are posing significant challenges for mothers and their infants. In the 2015 House Budget Committee proposal over the next 10 years, hospitals and health care systems are facing cuts approaching half a trillion dollars (Herman, 2014). These budget reductions are forcing hospitals to eliminate many health care services in the community, especially those in maternal child health (Abraham, 2011; Ferrara & Hunter, 2010; Kauffman, 2014). The proposed budget cuts are in addition to the 2006 Deficit Reduction Act (Pear, 2006), where children born in the United States to low-income, undocumented immigrants will no longer be automatically entitled to health insurance through Medicaid and the proposed Birthright Citizenship Act of 2013, and where children born to illegal immigrants will not be granted U.S. citizenship (King, 2013). Proposed cuts for the State Children's Health Insurance Program (SCHIP) have also occurred, which includes a 26% funding reduction by 2024 to various state public health services for low-income families (Park & Broaddus, 2014). The federal Medicaid law allows states the flexibility to impose cost sharing, thus increasing monthly premiums on Medicaid children (Jones & Flores, 2009; Kaiser Family Foundation, 2013; Omoto, 2011). These legislative acts are making access to health care difficult for nearly 30 million children (Waxman, 2011) and are creating major delays in newborns receiving routine and acute health care (American Academy of Pediatrics, 2014; Fedyszyn, 2011; Hannan, 2013). In addition, infant hospitalizations and mortality rates have increased (Abdullah et al., 2010; Lindell, 2011). The Agency for Healthcare Research and Quality (AHRQ) (2011a) reported that infants under one year of age accounted for 72% of all pediatric hospital discharges in 2009, an increase from 2000.
Unfortunately, there is very little reported literature on post-birth newborn morbidity for full-term infants within the first two months of life, a time of increased risk for mortality. The purpose of this study was to examine infant morbidity, associated health care charges, and access to post-birth health care in the first eight weeks of life in healthy, full-term infants born to low-income, first-time mothers.
Pediatr Nurs. 2014;40(3):121-126. © 2014 Jannetti Publications, Inc.
