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Do severe maternal morbidity and adequate prenatal care affect the delivery cost? A nationwide cohort study for 11 years with follow up

Authors
Nam, J. Y.Cho, E.Park, E. C.
Issue Date
Dec-2019
Publisher
WILEY
Keywords
Caesarean section; cohort study; delivery medical costs; prenatal care; severe maternal morbidity
Citation
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, v.126, no.13, pp.1623 - 1631
Journal Title
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY
Volume
126
Number
13
Start Page
1623
End Page
1631
URI
https://scholarworks.sookmyung.ac.kr/handle/2020.sw.sookmyung/2680
DOI
10.1111/1471-0528.15895
ISSN
1470-0328
Abstract
Objective To explore whether severe maternal morbidity (SMM) and adequate prenatal care (PNC) affect delivery cost. Design Population-based retrospective cohort study. Setting National Health Insurance Service National Sample Cohort in Korea. Population A total of 90 035 deliveries in 2003 and 2013. Methods Severe maternal morbidity was determined using the Centers for Disease Control and Prevention's algorithm. Delivery medical costs were calculated by estimating claimed total medical costs using year-specific inflation adjustment factors. Adequate PNC was estimated by the Kessner Adequacy of Prenatal Care Index. To estimate adjusted mean delivery medical costs related to SMM, we applied a generalised estimating equation model with log link and gamma distribution, by adjusting for all covariates. Main outcome measures Delivery cost was calculated by estimating claimed total medical cost during delivery hospitalisation using year-specific inflation. Results Of the 90 035 deliveries, 2041 (2.27%) involved SMM. Women with SMM had a greater adjusted mean cost of delivery (US$ 1,263, 95% CI US$ 1,196-1,334) than those without (US$ 740, 95% CI US$ 729-750). Interestingly, women who had inadequate PNC had higher delivery medical costs than those with adequate PNC, adjusted for all covariates. Conclusion Delivery involving SMM was associated with nearly doubled medical costs. Additionally, inadequate PNC increased the medical costs of delivery. The current study confirmed the burden of SMM and found that adequate PNC might be a useful preventive factor in reducing medical costs. Tweetable abstract We found that women with severe maternal morbidity and inadequate prenatal care had increased medical costs during delivery hospitalisation.
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