Tuesday, May 27, 2014

Twenty-five hundred grams

Twenty-five hundred grams (2,500 g) is the upper cut-off point for classifying infant birth weight as undesirably low.  A customary public health metric, low birth weight is defined as an infant weight of less than 2,500 g (equivalent to 5 pounds, 8 ounces), measured within one hour of birth.  As it relates to infant health at birth, as infant size declines, risk for early death and acute and chronic morbidity increases.  Low birth weight is a noteworthy public health concern because:  (1) it is a major risk factor for infant mortality; (2) it consumes a disproportionately high level of health care resources; and (3) its prevalence continues to rise despite investment of public resources aimed toward improving birth outcomes.      

Infant birth weight is one of the primary measures of infant health at birth, making it a central target of much public health policy in both the U.S. and globally.  It is a well documented predictor of neonatal health, infant survival, and future health and productivity (Currie, 2011, p.12; Martin et al., 2011; Almond, Chay, & Lee, 2005).  Public health entities and policy makers traditionally view infant birth weight as an indicator of overall health at the population level because poor birth weight outcomes reflect maternal undernutrition, chronic ill health, excessive physical exertion or stress, and poor health care during pregnancy (The World Health Organization [WHO], n.d.; Stevens-Simon & Orleans, M., 1999).  The WHO and others also note its importance as an indicator of a country or region's health care system's effectiveness in delivering life-saving, life enhancing interventions to its citizens (Almond et al., 2005; WHO, 2000).

Federal and state governments are heavily invested in financing medical care for childbirth associated maternal and infant health outcomes.  In the U.S., public funding sources finance the cost of health insurance coverage for a substantial number of infant deliveries and subsequent medical care.  The Federal-State Medical Assistance Program, better known as Medicaid, is the primary source of insurance for publicly financed infant deliveries.  Federal and state governments share the cost of providing pubic insurance for low-income residents who meet certain eligibility criteria, and states administer their respective programs.

In 2010, the U.S. recorded 3,854,224 million births.  Of those, Medicaid provided insurance coverage for 45% (1.75 million) of associated deliveries and just under half (48% or 1.86 million) were billed to private payers; those that made up the remaining portion (3% or 131,205) were either uninsured or covered by other miscellaneous government programs (Source:  Agency for Healthcare Research and Quality [AHRQ], Nationwide Inpatient Sample [NIS], n.d.).  AHRQ indicator data that tracks sources of insurance coverage for all U.S. hospital deliveries illustrate a steadily rising trend in public insurance financing for infant deliveries under current eligibility criteria.  And as federal health care reform progresses toward full implementation, eligibility criteria are likely to expand, at least in many states.


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