Association of Medicaid vs Marketplace Eligibility on Maternal Coverage and Access With Prenatal and Postpartum Care.
Association of Medicaid vs Marketplace Eligibility on Maternal Coverage and Access With Prenatal and Postpartum Care.
复制标题
DOI：
10.1001/jamanetworkopen.2021.37383
复制
发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Allen HL
中科院分区：
文献类型：
--
作者：
Eliason EL;Daw JR;Allen HL
在获得医疗补助资格的低收入女性中，预先受孕、产后保险和护理使用与市场保险相比如何？在这项对11名 432名低收入女性的队列研究中，医疗补助资格相对于市场资格与医疗补助覆盖率显著增加(20.3个百分点)、私人保险覆盖率下降(−10.8个百分点)以及未参保率(−8.7个百分点)在未孕期显著相关。这也与产后医疗补助增加(17.4个百分点)和适当的产前护理增加(4.4个百分点)有关，但与早期产前护理、产后检查或产后避孕没有显著变化。在这项研究中，符合医疗补助资格的女性的先入为主的未参保率较低，这表明低收入女性面临着进入市场的障碍。政策制定者正在考虑扩大保险范围，以改善产妇健康。扩大医疗补助或为产妇提供补贴的私人保险与护理之间的权衡尚不清楚。比较医疗补助的孕产妇覆盖率和护理与市场资格。采用差异性研究设计，于2020年3月14日至2021年4月22日进行了一项回溯性队列研究。对家庭收入100%至138%联邦贫困水平(FPL)的妇女(暴露组)进行了比较，这些妇女居住在10个医疗补助扩大地点(暴露组)，根据《平价医疗法案》获得了医疗补助资格，以及在5个非扩大地点(对照组)，他们在保险扩大实施之前(2011-2013年)和(2015-2018年)获得了市场资格。参与者包括2011-2018年怀孕风险评估监测系统调查中18岁或以上的妇女。根据《平价医疗法案》获得医疗补助或市场保险的资格。结果包括在怀孕前和产后期的覆盖范围、早期和充分的产前护理、产后检查和有效的避孕措施的使用。研究人群包括11名18岁及以上的 432名妇女(32%年龄18-24岁，33%年龄25-29岁，35%年龄≥30岁)，收入在100%至138%之间：7586人在医疗补助州(曝光组)，3846人在非扩张市场州(对照组)。市场国家的女性更年轻，受教育程度和结婚率更高，种族和民族多样性较低。相对于市场资格，医疗补助与医疗补助覆盖率(20.3个百分点；95%CI，12.8至30.0个百分点)、私人保险覆盖率(−10.8个百分点；95%CI，−13.3个百分点至−7.5个百分点)和未参保率(−8.7个百分点；95%CI，−20.1至−0.1个百分点)相关；在未孕期，产后医疗补助增加(17.4个百分点；95%CI，1.7至34.3个百分点)，以及适当的产前护理增加(4.4个百分点；95%可信区间，0.1-11.0个百分点)。没有证据表明在早期产前护理、产后检查或产后避孕方面存在显著差异。在这项队列研究中，获得医疗补助的资格与增加的医疗补助、较低的先入为主的保险和增加足够的产前护理使用有关。符合医疗补助条件的女性中先入为主的未参保率较低，这表明低收入女性在进入市场时面临障碍，这突显了减少低收入人群经济障碍的潜在重要性。这项队列研究考察了医疗补助与市场对低收入妇女产前和产后覆盖范围的变化，在根据《平价医疗法案》扩大医疗补助与不扩大医疗补助的州中。
How does preconception and postpartum coverage and care use compare among women with low incomes gaining eligibility for Medicaid vs marketplace coverage? In this cohort study of 11 432 women with low incomes, Medicaid eligibility relative to marketplace eligibility was associated with significantly increased Medicaid coverage (20.3 percentage points), decreased private insurance coverage (−10.8 percentage points), and decreased uninsurance (−8.7 percentage points) in the preconception period. It was also associated with increased postpartum Medicaid (17.4 percentage points) and increased adequate prenatal care (4.4 percentage points) but not with significant changes in early prenatal care, postpartum checkups, or postpartum contraception. The finding of lower rates of preconception uninsurance among Medicaid-eligible women in this study suggests that women with low incomes were facing barriers to marketplace enrollment. Policy makers are considering insurance expansions to improve maternal health. The tradeoffs between expanding Medicaid or subsidized private insurance for maternal coverage and care are unknown. To compare maternal coverage and care by Medicaid vs marketplace eligibility. A retrospective cohort study using a difference-in-difference research design was conducted from March 14, 2020, to April 22, 2021. Maternal coverage and care use were compared among women with family incomes 100% to 138% of the federal poverty level (FPL) residing in 10 Medicaid expansion sites (exposure group) who gained Medicaid eligibility under the Affordable Care Act and in 5 nonexpansion sites (comparison group) who gained marketplace eligibility before (2011-2013) and after (2015-2018) insurance expansion implementation. Participants included women aged 18 years or older from the 2011-2018 Pregnancy Risk Assessment Monitoring System survey. Eligibility for Medicaid or marketplace coverage under the Affordable Care Act. Outcomes included coverage in the preconception and postpartum periods, early and adequate prenatal care, and postpartum checkups and effective contraceptive use. The study population included 11 432 women age 18 years and older (32% age 18-24 years, 33% age 25-29 years, 35% age ≥30 years) with incomes 100% to 138% FPL: 7586 in a Medicaid state (exposure group) and 3846 in a nonexpansion marketplace state (comparison group). Women in marketplace states were younger, had higher educational level and marriage rates, and had less racial and ethnic diversity. Medicaid relative to marketplace eligibility was associated with increased Medicaid coverage (20.3 percentage points; 95% CI, 12.8 to 30.0 percentage points), decreased private insurance coverage (−10.8 percentage points; 95% CI, −13.3 to −7.5 percentage points), and decreased uninsurance (−8.7 percentage points; 95% CI, −20.1 to −0.1 percentage points) in the preconception period, increased postpartum Medicaid (17.4 percentage points; 95% CI, 1.7 to 34.3 percentage points) and increased adequate prenatal care (4.4 percentage points; 95% CI, 0.1 to 11.0 percentage points) in difference-in-difference models. No evidence of significant differences in early prenatal care, postpartum check-ups, or postpartum contraception was identified. In this cohort study, eligibility for Medicaid was associated with increased Medicaid, lower preconception uninsurance, and increased adequate prenatal care use. The lower rates of preconception uninsurance among Medicaid-eligible women suggest that women with low incomes were facing barriers to marketplace enrollment, underscoring the potential importance of reducing financial barriers for the population with low incomes. This cohort study examines changes in Medicaid vs marketplace prenatal and postpartum coverage of women with low incomes in states with vs without Medicaid expansion under the Affordable Care Act.
登录
查看更多内容
DOI：
10.1001/jamahealthforum.2021.0305
发表时间：
2021-03-01
期刊：
JAMA health forum
影响因子：
--
作者：
Gondi, Suhas;Song, Zirui
通讯作者：
Song, Zirui
影响因子：
3.3
作者：
Ahluwalia, Indu B.;Helms, Kristen;Morrow, Brian
通讯作者：
Morrow, Brian
影响因子：
3
作者：
Rokicki, Slawa;Cohen, Jessica;Landrum, Mary Beth
通讯作者：
Landrum, Mary Beth
影响因子：
2.3
作者：
Hosler, Akiko S.;Nayak, Seema G.;Radigan, Anne. M.
通讯作者：
Radigan, Anne. M.
影响因子：
2.3
作者：
Dietz, Patricia;Bombard, Jennifer;Taylor, Allan
通讯作者：
Taylor, Allan