However, health care costs are not the only expenditures associated with birth complications; other non-healthcare related costs, such as overall loss in productivity, also add to the total burden of complicated births. The Institute kinase inhibitors of Medicine estimated that preterm births alone cost the United States $26.2 billion in 2005 when accounting for health care along with other costs (Behrman & Butler, 2007). Moreover, the effects of poor birth outcomes extend beyond the neonatal period: they affect a child’s life course and health trajectory (Behrman & Butler, 2007; Wise, 2004) and are

associated with lifelong conditions, including learning and behavioral problems, asthma, and increasing evidence of lifelong cardiovascular issues (McCormick, Litt, Smith, & Zupancic, 2011). This creates a significant financial burden on families who care for infants born with complications (Wise, 2004). In response to the cost and high prevalence of poor birth outcomes—which are higher in the United States than other developed countries (IOM, 2013)—a number of initiatives have been launched by the Centers for Medicare & Medicaid Services (CMS), the U.S. Health Resources and Services Administration (HRSA), and others aimed at improving birth outcomes (CMS, 2013; HRSA, 2013). In the future, it will be important to follow trends in complicated births to ascertain

effects. Limited studies exist on trends in hospital stays related to

births in the U.S. In their analysis of HCUP data, Friedman et al. (2011) reported reductions in births overall, particularly births to adolescent mothers, but incidences and implications of trends in complicated births were not examined. Nor were trends in complications examined in the context of payer type or particular diagnoses. Other analyses examining complicated births have focused on maternal hospitalizations (Elixhauser & Wier, 2011, May) or on cross-sectional data (Elixhauser & Wier, 2011, May; Russell et al., 2007) and not on trends, expected payer sources, or implications for health care policy and spending. This study is intended to fill gaps in prior research and to provide a baseline against which to evaluate the effects of recent efforts to improve birth outcomes. This baseline will be Anacetrapib especially valuable given the expected growth of public coverage, both through Medicaid expansion and the subsidized coverage in the Insurance Exchanges (Kenney, Lynch, Cook, & Phong, 2010). The purpose of this paper is two-fold. First, the paper examines overall trends in utilization, costs, and expected source of payment for complicated newborn hospital stays using all-payer discharge data from 2002 through 2009. Second, the paper provides an in-depth look at the most prevalent diagnoses for complicated newborn stays by expected payer type in 2009.