Association of Childbirth With Medical Debt

Abstract

We evaluated the association between childbirth and having medical debt in collections and examined differences by neighborhood socioeconomic status. Among a statewide cohort of commercially insured pregnant (n=14,560) and postpartum (n=12,157) adults, having medical debt in collections was more likely among postpartum individuals compared with pregnant individuals (adjusted odds ratio [aOR] 1.36, 95% CI 1.27–1.46) and those in lowest-income neighborhoods compared with all others (aOR 2.18, 95% CI 2.02–2.35). Postpartum individuals in lowest-income neighborhoods had the highest predicted probabilities of having medical debt in collections (28.9%, 95% CI 27.5–30.3%), followed by pregnant individuals in lowest-income neighborhoods (23.2%, 95% CI 22.0–24.4%), followed by all other postpartum and pregnant people (16.1%, 95% CI 15.4–16.8% and 12.5%, 95% CI 11.9–13.0%, respectively). Our findings suggest that current peripartum out-of-pocket costs are objectively more than many commercially insured families can afford, leading to medical debt. Policies to reduce maternal–infant health care spending among commercially insured individuals may mitigate financial hardship and improve birth equity.