Association between level of delivery hospital and neonatal Outcomes among South Carolina Medicaid recipients

OBJECTIVE: The purpose of this study was to examine relationships between level of delivery hospital and neonatal mortality rate, length of stay, and Medicaid reimbursement. STUDY DESIGN: This was a retrospective cohort study of 2560 infants with birth weights between 500 and 1499 g who were born between 1991 and 1995 to South Carolina mothers and whose care was covered by Medicaid. RESULTS: The relative risk of neonatal death for infants born in level I and II hospitals (relative risk, 1.9, 95% confidence interval, 1.6-2.2) but not level II hospitals with 24-hour neonatology coverage (relative risk, 1.2, 95% confidence interval, 0.7-1.9) was higher than that for infants born in level III hospitals. Compared with infants born in level III hospitals mean length of stay was longer and Medicaid reimbursement was similar for infants born in level I and II hospitals. Among infants born in level II hospitals with 24-hour neonatology coverage length of stay was shorter and Medicaid reimbursement was lower. CONCLUSION: Infants born in level I and II hospitals had higher neonatal mortality rates and longer stays than did infants born in level III hospitals, despite similar Medicaid reimbursement.