Research Findings #27: Health Care Expenditures for
Uncomplicated Pregnancies
Steven R. Machlin and Frederick Rohde, Agency for Healthcare Research and Quality.
Abstract
This report uses data pooled from three panels 2001-02, 2002-03, 2003-04 of
the Household Component of the Medical Expenditure Panel Survey MEPS-HC
to estimate medical expenditures in 2004 dollars associated with an uncomplicated
pregnancy and in-hospital delivery. Medical expenditures are defined in
MEPS as payments to hospitals, physicians, pharmacies, and other health care
providers, and include direct payments by individuals, private and public insurance
plans, and other miscellaneous payment sources for services received.
The report presents selected person-level estimates of average expenditures and
sources of payment for 1 prenatal care, 2 inpatient hospital delivery, and 3 the
combination of the two. In addition, selected estimates of prenatal care expenses
are broken into three types: office-based doctor visits, prescription medicines, and
everything else combined. Estimates are shown for all women, as well as for two
subgroups defined by insurance status: those who had private insurance in the
month of delivery and in the eight months prior, and those who had Medicaid in
the month of delivery and in the eight months prior.
The estimates in this report are based on the most recent data available at the time
the report was written. However, selected elements of MEPS data may be revised
on the basis of additional analyses, which could result in slightly different
estimates from those shown here. Please check the MEPS Web site for the most
current file releases.
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
http://www.meps.ahrq.gov
The Medical Expenditure Panel Survey (MEPS)
Background
The Medical Expenditure Panel Survey (MEPS) provides nationally representative
estimates of health care use, expenditures, sources of payment, and health insurance
coverage for the U.S. civilian noninstitutionalized population. MEPS is co-sponsored by
the Agency for Healthcare Research and Quality (AHRQ) and the National Center for
Health Statistics (NCHS), and has been conducted annually since 1996. The predecessor
surveys to MEPS were the 1977 National Medical Care Expenditure Survey (NMCES,
also known as NMES-1) and the 1987 National Medical Expenditure Survey (NMES-2).
MEPS is a family of three surveys. The Household Component (HC) is the core survey
and also forms the basis for the Medical Provider Component (MPC). Together these
two surveys yield comprehensive data that provide national estimates of the level and
distribution of health care use and expenditures, support health services research, and
can be used to assess health care policy implications. The third survey, the Insurance
Component (IC), is a survey of private and public sector employers that provides
national- and state-level estimates of employer-sponsored health insurance coverage and
cost.
Household Component
The MEPS-HC, a nationally representative survey of the U.S. civilian
noninstitutionalized population, collects medical expenditure data at both the person and
household levels. Using computer-assisted personal interviewing (CAPI) technology, the
HC collects detailed data on demographic characteristics, health conditions, health
status, use of medical care services, charges and payments, access to care, satisfaction
with care, health insurance coverage, income, and employment.
The HC is based on an overlapping panel design in which data covering a two-year
period are collected through a preliminary contact followed by a series of five rounds of
interviews over a two-and-a-half-year period. Data on medical expenditures and use for
two calendar years are collected from each household. This series of data collection
rounds is launched each year on a new sample panel of households, and annual data are
developed by combining data from the first year of the new panel with that from the
second year of the previous panel.
Each year’s sample for the MEPS-HC is drawn from respondents to the previous year’s
National Health Interview Survey (NHIS). The NHIS provides a nationally representative
sample of the U.S. civilian noninstitutionalized population, with an over-sampling
of Hispanics and blacks that carries over to the MEPS sample. In addition, the MEPS
sample design over-samples Asians and persons in low income families.
Medical Provider Component
The MEPS-MPC collects data from providers that are primarily used to supplement
and/or replace information on medical care expenditures reported in the MEPS-HC. The
survey contacts medical providers and pharmacies identified by household respondents
and for which signed Health Insurance Portability and Accountability Act of 1996
(HIPAA) compliant permission forms have been obtained from family members who
received services from the medical providers and pharmacies.
The MPC sample includes all hospitals, emergency rooms, home health agencies,
outpatient departments, and pharmacies reported by HC respondents as well as all
physicians who provide services for patients in hospitals but bill separately from the
hospital. Office-based medical providers for which the provider is either a doctor of
medicine (MD) or Osteopathy (DO), or practices under the direct supervision of an MD
or DO, are included in the MPC as well.
Data are collected on medical and financial characteristics of medical and pharmacy
events reported by HC respondents. These data include dates of visit, diagnosis and
procedure codes, charges, and payments. These data allow records to be matched with
household events to facilitate expenditure imputation. The MPC was not designed as a
stand-alone survey to generate national estimates. The MPC data are collected from
sampled providers through an initial screening telephone contact to verify provider
eligibility, a mailed or faxed questionnaire, and a phone call to collect the data. Many
providers prefer to send electronic, fax, or hard copies of records from which the
necessary information can be abstracted. To supplement abstraction, telephone calls are
placed to providers to clarify items, obtain critical information that may be missing, and
follow up on nonresponse.
Insurance Component
The MEPS-IC collects data on health insurance plans obtained through private and
public sector employers. Data obtained in the IC include the number and types of private
insurance plans offered, benefits associated with these plans, premiums, contributions by
employers and employees, eligibility requirements, and employer characteristics.
Establishments participating in the MEPS-IC are selected through two sampling frames:
- A U.S. Census Bureau list frame of private sector business establishments.
- The Census of Governments from the U.S. Census Bureau.
Data from these two Census Bureau sampling frames are used to produce annual national
and state estimates of the supply and cost of private health insurance available to
American workers and to evaluate policy issues pertaining to health insurance. National estimates of employer contributions to group insurance from the MEPS-IC are used in the computation of Gross Domestic Product (GDP) by the Bureau of Economic Analysis.
The MEPS-IC is an annual survey. Data are collected from the selected organizations through a prescreening telephone interview, a mailed questionnaire, and a telephone follow-up for nonrespondents.
Survey Management
MEPS-HC data are collected under the authority of the Public Health Act. Data are
collected under contract with Westat, Inc. Data sets and summary statistics are edited
and published in accordance with the confidentiality provisions of this Act and the
Privacy Act. NCHS provides consultation and technical assistance.
MEPS-IC data are collected under the authority of the Public Health Service Act and
under the authority provided in Title 13, United States Code (U.S.C.). The data are
collected under an interagency agreement with the U.S. Census Bureau. Data sets and
summary statistics are edited and published in accordance with the confidentiality
provisions of this Act, Title 13 U.S.C., and the Privacy Act.
As soon as data collection and editing are completed, the MEPS survey data are released
to the public in staged releases of summary reports, microdata files, and tables via the
MEPS Web site: www.meps.ahrq.gov. (MEPS-IC microdata files are confidential and
are only accessible for approved research projects at the Census Bureau’s Research Data
Centers.) Selected data can be analyzed through MEPSnet, an online interactive tool
designed to give data users the capability to statistically analyze MEPS data in a menudriven
environment. Additional information on MEPS is available from the MEPS
project manager or the MEPS public use data manager at the Center for Financing
Access and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither
Road, Rockville, MD 20850 (301) 427-1406.
Introduction
Although there have been more than 4 million births each year in the United States since
2000,1 there is little information in the literature regarding the average medical expenditures
generated over the course of a pregnancy. This analysis uses data pooled from
three panels of the Household Component of the Medical Expenditure Panel Survey
(MEPS-HC) to estimate medical expenditures (in 2004 dollars) associated with an
uncomplicated pregnancy and in-hospital delivery. Medical expenditures are defined in
MEPS as payments to hospitals, physicians, pharmacies, and other health care providers,
and include direct payments by individuals, private and public insurance plans, and other
miscellaneous payment sources for services received.
This report presents selected person-level estimates of average expenditures and sources
of payment for 1) prenatal care, 2) inpatient hospital delivery, and 3) the combination of
the two. In addition, selected estimates of prenatal care expenses are broken into three
types: those for office-based doctor visits, those for prescription medicines, and those for
everything else combined. Estimates are shown for all women, as well as for two
subgroups defined by insurance status: those who had private insurance in the month of
delivery and in the eight months prior, and those who had Medicaid in the month of
delivery and in the eight months prior.
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Methods
MEPS-HC collects data from a nationally representative sample of households through
an overlapping panel design. A new panel of sample households is selected each year,
and data for each panel are collected for two calendar years.2 Due to the very small
sample size of women in a panel who are in the survey for the course of a full-term
pregnancy, we pooled data across three panels (2001-02, 2002-03, and 2003-04) for the
analysis. Women from these panels who met each of the following three criteria were
included: 1) had an inpatient event where the reported reason for the hospitalization was“to give birth,” 2) the Clinical Classification Code (CCS)3 for the event was 196
(“normal pregnancy and delivery”), and 3) were in the survey for at least 38 consecutive
weeks (period of a full-term pregnancy) prior to the date of delivery. This definition
necessarily excluded all non-inpatient deliveries as well as all inpatient deliveries with
complications; e.g., hypertension or diabetes complicating childbirth; early labor or
prolonged delivery; and malpositioned, obstructed, or forceps deliveries. Deliveries by
Caesarean section are included in the analysis unless they had been coded as a
complication of birth (CCS code of 195).
The delivery expenditures are those associated with the woman’s inpatient event and
include payments both to the facility and to any separately billing doctors. Prenatal care
expenditures were obtained by compiling the medical events from other event types
(office-based, prescription medicines, hospital outpatient, hospital inpatient [excluding
the delivery event], home health, and other medical) that linked to a normal pregnancy
and delivery condition on the inpatient event record for the delivery. This method
insured, for instance, that expenditures for any prescription drugs related to the
pregnancy (e.g., prenatal vitamins) were included while expenditures for other drugs that
were taken to treat a separate condition (e.g., a diuretic to treat an existing hypertension
condition) were not included. The expenditures for events that linked to both the normal
pregnancy and delivery condition and some other condition were considered pregnancy
related and included.
Using detailed information collected in MEPS about the type of insurance carried by
each sample person in any month of the year, each woman’s insurance status was
classified according to the type of insurance she carried in the month of delivery and in
the eight months prior to the delivery event. If she had private insurance or Armed
Forces–related coverage (TRICARE) the entire period, then she was classified as
privately insured. If she was covered by Medicaid the entire period, then she was
classified as having Medicaid coverage.
MEPS longitudinal panel weights are designed for estimates across a consecutive twoyear
period and were used to develop all estimates in this report.4 Expenditures for
events that occurred prior to 2004 were adjusted to 2004 dollars using the Producer Price
Index (PPI) and the Consumer Price Index (CPI).5 All differences discussed in the text
are statistically significant at the .05 level.
1 National Center for Health Statistics. Health United States, 2006. Hyattsville, Md.: 2006.
2 See
http://www.meps.ahrq.gov/mepsweb/survey_comp/hc_data_collection.jsp.
3 The CCS was developed by AHRQ to collapse the 13,000 individual ICD-9 condition and 3,700
individual ICD-9 procedure codes into smaller sets of clinically meaningful categories. For more
information, go to http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.
4 The unweighted sample sizes for this analysis are 774 women overall, 341 privately insured women,
and 164 women on Medicaid. A small number of pregnancies were excluded from the analysis
because survey data were not complete on date of admission for the hospital delivery or it was the
first of two pregnancies for a woman during the survey period.
5 All hospital-related expenditures (from inpatient, outpatient, or emergency room visits) were
adjusted to 2004 dollars using the PPI; all other expenditures (office-based, home health, prescribed
medicines, or other medical visits) were adjusted to 2004 dollars using the CPI. Go to
http://www.bls.gov/ppi for more information about the PPI and http://www.bls.gov/cpi
for more information about the CPI.
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Highlights
- The average total expenditure for prenatal care services during pregnancy and an
inpatient hospital delivery combined was about $7,600 (in 2004 dollars). Expenses for prenatal care (office visits, prescribed medicines, and other services) were substantially smaller than for the hospital delivery.
- While average expenses for prenatal care were similar for privately insured women and women on Medicaid, average expenses for hospital delivery were about $2,000 more for privately insured women.
- On average, women who were privately insured paid substantially higher proportions of prenatal care expenses and delivery expenses out of pocket than women on Medicaid.
- Over 90 percent of women had expenses for office-based visits during pregnancy.
However, mean total expenses for office visits were on average about $500 higher
for privately insured women than for women on Medicaid.
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Findings
Table 1 shows selected characteristics of women with a normal pregnancy that both
began and concluded (with a normal hospital delivery) within a two-year interval
spanning January 1 through December 31 of the subsequent year (across three periods
pooled for this analysis: 2001-02, 2002-03, and 2003-04). Over half of the women (53
percent) were age 25–34, about two-thirds were married, and about two-thirds were
neither Hispanic nor black non-Hispanic (i.e., mainly white non-Hispanic). Compared to
privately insured women, those on Medicaid were more likely to be under 25 years of
age (53 percent versus 16 percent), not married (72 percent versus 13 percent), and have
family income below the Federal poverty line (66 percent versus 6 percent).
Table 2 shows the conditional6 average (mean and median) expenditures in 2004 dollars
for a normal pregnancy and delivery. The conditional mean amount for a normal
pregnancy (prenatal care and delivery) was $7,564. Mean expenses for the delivery
($5,850) were just over three-quarters of the mean for the combined total. On average,
delivery expenses were almost $2,000 more for privately insured women than for women
on Medicaid ($6,520 versus $4,577), but the means were similar for prenatal care
expenses (about $2,000).
Table 3 shows the mean of the person-level percent of the expenditures paid by the
various sources. On average across all women, private insurance paid for 52 percent and
Medicaid paid for 34 percent of total expenses for prenatal care and delivery. The
remaining portions were paid out of pocket (6 percent on average) and by miscellaneous
other sources7 (8 percent on average). Among women who were privately insured,
private insurance paid an average of 88 percent of the delivery and 80 percent of the
prenatal care expenses, while an average of 7 percent of the delivery expenses and 16
percent of the prenatal care expenses were paid out of pocket. Among women who were
on Medicaid, Medicaid paid for an average of 92 percent of total expenses for prenatal
care and delivery (the difference in proportions paid by Medicaid for delivery versus
prenatal care was not statistically significant). Women on Medicaid paid an average of 4
percent of prenatal care expenses and less than 1 percent of delivery expenses out of
pocket.
Table 4 shows the conditional average expenditures for prenatal care, broken down into
those for office-based visits, those for prescription medicines, and those for all other
categories of expenses. About 9 of every 10 women had expenses for office-based visits
regardless of type of insurance coverage. However, conditional mean expenses for office
visits were an average of $547 higher for privately insured women than for women on
Medicaid ($1,474 versus $927). Only 22 percent of women had some prescription drug expenses associated with their pregnancy. The large difference between the conditional
mean ($1,784) and median ($640) values for these expenses indicate that a small
proportion of women had extremely large expenses.8 About three-quarters of the drug
expenditures were for prescription nutritional products (such as prenatal vitamins), about
10 percent was for analgesics, and the remaining expenditures were spread out among
the various therapeutic categories (estimates not shown in tables). About two-thirds of
the women (67 percent) had other types of expenditures during pregnancy, but the level
of these expenses was small (overall conditional mean of $224) compared to that for
office visits and prescribed medicines. As with prescribed medicine expenditures, the
large difference between the mean and median value ($224 and $59, respectively) for
other expenses indicates that a small proportion of cases had relatively high
expenditures. Medians for the other expenditure category were not significantly different
for privately insured women ($66) versus women on Medicaid ($75).
6 The conditional average expenditure is the average expenditure among just the women with an
expense. Less than 1 percent of women had no expenses for the hospital delivery (i.e., nothing was
paid to the hospital).
7 Includes sources such as community and neighborhood clinics, State and local health departments,
State programs other than Medicaid, and Federal sources such as the Indian Health Service and
military treatment facilities.
8 The average amount spent for prescribed medicines is not shown in the table for the privately
insured and Medicaid subgroups due to small sample sizes and large standard errors.
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Data Source
The estimates in this analysis are based on data obtained from all MEPS annual full-year
consolidated person-level and annual event-level files for 2001-2004. These files are
available at http://www.meps.ahrq.gov/mepsweb/data_stats/download_data_files.jsp.
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Tables showing data on use and expenditures for antihypertensive drugs:
| Table 1. Selected characteristics of women with uncomplicated pregnancies, by insurance
status. |
| |
|
Privately
insured |
Medicaid |
| Population subgroup |
Percent |
SEb |
Percent |
SEb |
Percent |
SEb |
| Overall |
| Overall |
100.0 |
0.0 |
100.0 |
0.0 |
100.0 |
0.0 |
| Age category |
| <25 |
32.7 |
1.8 |
16.1 |
2.0 |
52.9 |
4.8 |
| 25-34 |
53.3 |
1.9 |
64.6 |
2.5 |
41.9 |
4.7 |
| 35+ |
14.0 |
1.5 |
19.3 |
2.2 |
5.3 |
1.6 |
| Race/ethnicity |
| Hispanic |
18.8 |
1.6 |
10.6 |
1.7 |
20.0 |
3.2 |
| Black non-Hispanic |
12.9 |
1.3 |
6.7 |
1.4 |
24.5 |
3.6 |
| Other non-Hispanic |
68.3 |
2.0 |
82.7 |
2.1 |
55.5 |
5.1 |
| Marital status |
| Married |
67.4 |
1.9 |
86.7 |
1.9 |
28.3 |
4.9 |
| Not married |
32.6 |
1.9 |
13.3 |
1.9 |
71.8 |
4.9 |
| Poverty level categoryc |
| Below Federal poverty line |
26.9 |
1.8 |
5.7 |
1.1 |
65.6 |
4.6 |
| At or above Federa poverty line |
73.1 |
1.8 |
94.3 |
1.1 |
34.4 |
4.6 |
a Includes women who were insured for some but not all months of the pregnancy and those with coverage types
other than private insurance or Medicaid (in addition to women covered by private insurance or Medicaid throughout
their pregnancy).
b Standard error
c Poverty status is based on the ratio of the family’s income to the Federal poverty thresholds, which control for the
size of the family and the age of the head of the family (see the 2004 U.S. Department of Health and Human
Services Poverty Guidelines at http://aspe.hhs.gov/poverty/04poverty.shtml for more details). |
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| Table 2. Conditional average expenditures (2004 dollars) per woman, by insurance status throughout pregnancy. |
| |
Prenatal care and delivery combined |
Prenatal care |
Delivery |
| |
Estimate |
SEa |
Estimate |
SEa |
Estimate |
SEa |
| All women |
| Percent with an expense |
|
|
92.9 |
1.1 |
|
|
| Conditional mean (dollars) |
7,564 |
191.2 |
1,852 |
94.2 |
5,850 |
157.9 |
| Conditional median (dollars) |
6,542 |
205.2 |
1,159 |
53.7 |
5,027 |
154.9 |
| Privately insured |
| Percent with an expense |
|
|
93.9 |
1.5 |
|
|
| Conditional mean (dollars) |
8,366 |
278.0 |
1,962 |
119.4 |
6,520 |
235.7 |
| Conditional median (dollars) |
7,625 |
244.3 |
1,315 |
121.3 |
5,872 |
256.0 |
| Medicaid |
| Percent with an expense |
|
|
91.6 |
2.1 |
|
|
| Conditional mean (dollars) |
6,540 |
484.1 |
2,142 |
391.8 |
4,577 |
282.6 |
| Conditional median (dollars) |
5,242 |
323.8 |
963 |
125.2 |
3,928 |
244.3 |
a Standard error
-- Over 99 percent of women had expenses for the hospital delivery (i.e., nothing was paid to the hospital for less than 1 percent
of deliveries). |
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| Table 3. Mean percentage of expenditures per woman paid by various sources, by insurance status
throughout pregnancy. |
| |
Prenatal care and delivery combined |
Prenatal care |
Delivery |
| |
Estimate |
SEa |
Estimate |
SEa |
Estimate |
SEa |
| All women |
| % paid by private insurance |
52.2 |
2.1 |
49.0 |
2.1 |
52.9 |
2.1 |
| % paid by Medicaid |
33.8 |
2.1 |
30.4 |
2.0 |
34.9 |
2.1 |
| % paid put of pocket |
6.3 |
0.4 |
13.3 |
1.0 |
4.9 |
0.5 |
| % paid by other sources |
7.6 |
0.9 |
7.3 |
1.0 |
7.2 |
1.0 |
| Privately insured |
| % paid by private insurance |
87.0 |
1.3 |
80.1 |
1.6 |
88.1 |
1.3 |
| % paid put of pocket |
7.9 |
0.7 |
15.7 |
1.3 |
6.6 |
0.7 |
| % paid by other sources |
5.2 |
1.1 |
4.2 |
1.0 |
5.3 |
1.2 |
| Medicaid |
| % paid by Medicaid |
91.5 |
2.1 |
87.3 |
2.8 |
93.1 |
2.1 |
| % paid put of pocket |
0.8* |
0.3 |
4.2* |
1.7 |
0.4* |
0.3 |
| % paid by other sources |
7.8 |
2.1 |
8.6 |
2.3 |
6.5* |
2.0 |
a Standard error
*Relative standard error > 30 percent |
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| Table 4. Average expenditures (2004 dollars) per woman for pregnancy-related office-based visits, prescription medicines, and other expenses, by insurance status throughout pregnancy. |
| |
Office-based visits |
Prescription
medicines |
Other expenses |
| |
Estimate |
SEa |
Estimate |
SEa |
Estimate |
SEa |
| All women |
| Percent with an expenseb |
91.9 |
1.2 |
22.0 |
1.8 |
67.3 |
1.9 |
| Conditional mean (dollars) |
1,281 |
56.2 |
1,784 |
281.8 |
224 |
35.8 |
| Conditional median (dollars) |
907 |
43.5 |
640 |
72.8 |
59 |
4.2 |
| Privately insured |
| Percent with an expenseb |
92.5 |
1.6 |
23.2 |
2.6 |
70.6 |
2.5 |
| Conditional mean (dollars) |
1,474 |
86.8 |
* |
* |
186 |
40.2 |
| Conditional median (dollars) |
1,080 |
71.7 |
* |
* |
66 |
5.4 |
| Medicaid |
| Percent with an expenseb |
90.1 |
2.6 |
20.0 |
3.7 |
61.6 |
4.6 |
| Conditional mean (dollars) |
927 |
67.5 |
* |
* |
585** |
182.5 |
| Conditional median (dollars) |
660 |
92.4 |
* |
* |
75 |
14.8 |
a Standard error
b Women without expenses include those with no service as well as those who received services for which no payments were
made by any source.
* Estimates not shown due to small sample size.
** Relative standard error > 30 percent |
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Suggested
Citation: Research Findings #27:Health Care Expenditures for
Uncomplicated Pregnancies. August 2007. Agency
for Healthcare Research and Quality, Rockville,
MD.
http://www.meps.ahrq.gov/data_files/publications/rf27/rf27.shtml |
|
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