Prevalence of Chronic Illness in Pregnancy, Access to Care, and Health Care Costs: Implications for Interconception Care
Received 4 January 2008; received in revised form 6 May 2008; accepted 24 June 2008. published online 27 October 2008.
Purpose
Access to health care after pregnancy is especially important for pregnant women with chronic illness. The purpose of our study was to describe the prevalence of chronic illness in pregnant women and factors affecting the receipt of ongoing care.
Methods
We conducted a cross-sectional analysis of 6,294 women between 19 and 45 years of age from the Medical Expenditure Panel Survey (MEPS). Chronic illness was defined using aggregate clinical classification codes in the MEPS. Women were divided into 4 groups: pregnant and currently not pregnant, with and without chronic illness. We analyzed group differences in demographic variables, socioeconomic status, and access to health care. We also estimated inpatient, outpatient, emergency room, and pharmacy expenditures for the 4 study groups. All analyses accounted for the complex survey design of MEPS.
Main Findings
Overall, 27% of pregnant women and 39% of nonpregnant women reported a chronic illness. There were no differences in race/ethnicity, poverty, or health insurance status between pregnant women with and without chronic illness. Women with chronic illness were more likely to have a usual source of care. Among pregnant women, the presence of a chronic condition did increase out-of-pocket expenditures, but did not increase total average health care expenditures, even after adjusting for other characteristics.
Conclusion
Pregnant women with chronic illness were similar to pregnant women without chronic illness in terms of access to care and total health care costs. Further research is needed to determine whether these similarities persist after delivery, given the relatively high prevalence of women with chronic illness who are of childbearing age.
aCenter for Health Quality, Outcomes and Economic Research (CHQOER), ENRM VA (152), Bedford, Massachusetts
bBoston University School of Public Health, Department of Health Policy and Management, Boston, Massachusetts
cBoston University School of Public Health, Department of Maternal and Child Health, Boston, Massachusetts
dDepartment of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
eInstitute for Health, Healthcare Policy, and Aging Research, Rutgers University New Brunswick, New Jersey
fHSR&D Center for Healthcare Knowledge Management VANJHCS, East Orange, New Jersey
Correspondence to: Sharmila Chatterjee, MD, MPH, 200 Springs Road, ENRM VA (152), Bedford, MA 01730; Phone: 781-687-2857; Fax: 781-687-2227
The authors have no direct financial interests that might pose a conflict of interest in connection with the submitted manuscript.
ABSTRACT