Assessing Perinatal Insurance Coverage at Time of Death: A National Survey of Maternal Mortality Review Committees

Background: The objective of this study is to understand the proportion of Maternal Mortality Review Committees (MMRCs) that investigate insurance status at the time of maternal deaths occurring during three time periods: pregnancy, childbirth, and up to 12 months postpartum. Materials and Methods: We conducted a national survey of MMRCs between July and September of 2020. Jurisdictions were e-mailed a 17-item questionnaire that addressed whether the MMRCs document insurance status for each of the three time periods as well as facilitators and barriers to doing so. Descriptive statistics were performed. Follow-up interviews were conducted with five MMRCs between November and December of 2020 to assess unique strategies and challenges discovered in their survey responses. Results: Among 46 eligible jurisdictions, 37 completed the survey (80.4%). The vast majority of MMRCs reported documenting insurance status during pregnancy (97.3%, 36/37) and childbirth (88.4%, 30/34). Fewer MMRCs reported documenting insurance status at the time of death for deaths that occur postpartum (59.4%, 19/32). Barriers to doing so included limited access to postpartum insurance data and a historic focus on deaths occurring during pregnancy and in association with childbirth. Conclusions: MMRCs primarily focus on identifying insurance status during pregnancy and at childbirth. Information on insurance status in the postpartum period is more difficult to ascertain and less often determined. The findings from this work should inform efforts for MMRCs to improve data collection on insurance status and ultimately improve the capacity of MMRCs to identify targeted insurance policy reforms that could help reduce maternal mortality.