Effect of covering perinatal health-care costs on neonatal outcomes in Switzerland: a quasi-experimental population-based study.
Effect of covering perinatal health-care costs on neonatal outcomes in Switzerland: a quasi-experimental population-based study.
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覆盖围产期保健费用对瑞士新生儿结局的影响：一项基于人群的准实验研究。
DOI：
10.1016/s2468-2667(23)00001-4
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Epure AM
中科院分区：
文献类型：
--
作者：
Epure AM
研究背景低出生体重和早产与新生儿死亡和整个生命过程中慢性疾病的风险增加有关。减少这些不利的生育结果是全球公共卫生的优先事项，需要制定改善怀孕期间保健的战略。我们的目的是评估的影响，瑞士的健康政策扩展完全覆盖疾病相关的费用在怀孕期间对新生儿baby.MethodsWe实施了一个准实验差异回归不连续性设计，以评估瑞士的健康保险（2014年3月1日）的影响，以充分覆盖医疗保健费用在怀孕期间和产后8周，对新生儿的结果。在这一改革之前，只支付正常妊娠标准监测的具体费用。2014年3月1日之前出生的婴儿及其母亲被分配到未暴露组，2014年3月1日或之后出生的婴儿及其母亲被分配到暴露组。我们纳入了2014年3月1日前后9个月内在瑞士出生的几乎所有儿童，以及2012年、2016年和2018年的对照年份。结局包括出生体重、低出生体重、极低出生体重、胎龄、早产或极早产和新生儿死亡。我们使用参数回归模型估计了该政策的意向治疗效果。发现2014年3月1日之前9个月出生的儿童有61 910名，之后9个月出生的儿童有63 991名。在三个控制日期前后的同一时间段内，有382 861名儿童出生。在政策实施前，平均出生体重为3289 g，胎龄为275天，6.5%的儿童低出生体重，1.0%的儿童极低出生体重，7.1%的儿童早产，0.4%的儿童极早产，0.3%的儿童在出生后28天内死亡。政策实施后（与实施前相比），平均出生体重增加23 g（95% CI 5 - 40），低出生体重儿的预测比例下降0.81%（0.14 - 1.48），极低出生体重儿的预测比例下降0.41%（0.17 - 0.65）。在敏感性分析中，对极低出生体重的影响并不稳健。该政策对胎龄的影响可忽略不计（平均差异1天，95%CI 0至1），对其他检查结果无明显影响。早产的预测比例变化为-0statistics39%（95%CI-1statistics2至0.38），极早产的预测比例变化为-0statistics09%（-0statistics27至0.08），新生儿死亡的预测比例变化为-0statistics07%（-0statistics2至0.07）。扩大卫生保健覆盖面是一项相关的卫生系统干预措施，可降低新生儿以及整个生命过程中的不良健康后果风险。
BackgroundLow birthweight and preterm birth are associated with an increased risk of neonatal death and chronic conditions across the life course. Reducing these adverse birth outcomes is a global public health priority and requires strategies to improve health care during pregnancy. We aimed to assess the effect of a Swiss health policy expansion fully covering illness-related costs during pregnancy on health outcomes in newborn babies.MethodsWe implemented a quasi-experimental difference in regression discontinuity design to assess the effect of expansion of Swiss health insurance (on March 1, 2014), to fully cover health-care costs during pregnancy and 8 weeks postpartum, on neonatal outcomes. Before this reform, only costs specific to the standard monitoring of a normal pregnancy were covered. Babies born before March 1, 2014, and their mothers were assigned to the unexposed group, and babies born on or after March 1, 2014, and their mothers were assigned to the exposed group. We included nearly all children born 2011–19 in Switzerland within a period of 9 months around the date March 1, 2014, and control years 2012, 2016, and 2018. Outcomes were birthweight, low birthweight, very low birthweight, gestational age, preterm or extremely preterm birth, and neonatal death. We estimated the intention-to-treat effect of the policy using parametric regression models.Findings61 910 children were born 9 months before and 63 991 were born 9 months after March 1, 2014. 382 861 children were born in the same time period around the three control dates. In the period before policy implementation, mean birthweight was 3289 g, gestational age was 275 days, and 6·5% of children had low birthweight, 1·0% very low birthweight, 7·1% were preterm, 0·4% were extremely preterm, and 0·3% died within the first 28 days of life. After initiation of the policy (vsbefore) mean birthweight increased by 23 g (95% CI 5 to 40) and the predicted proportion of low birthweight births decreased by 0·81% (0·14 to 1·48) and of very low birthweight births decreased by 0·41% (0·17 to 0·65). The effect on very low birthweight was not robust in sensitivity analyses. The policy had a negligible effect on gestational age (mean difference 1 day, 95% CI 0 to 1) and no clear effects on the other examined outcomes. The change in predicted proportion for preterm births was –0·39% (95% CI –1·2 to 0·38), for extremely preterm births was –0·09% (–0·27 to 0·08), and for neonatal death was –0·07% (–0·2 to 0·07).InterpretationFree access to prenatal care in Switzerland reduced the risk of some adverse health outcomes in newborn babies. Expanding health-care coverage is a relevant health system intervention to reduce the risk of adverse health outcomes in the newborn baby and, potentially, across the life course.FundingSwiss National Science Foundation.
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影响因子：
10.7
作者：
Hoynes, Hilary;Schanzenbach, Diane Whitmore;Almond, Douglas
通讯作者：
Almond, Douglas
怀孕前的现金转移和婴儿健康。
影响因子：
3.5
作者：
Libertad González;Sofia Trommlerová
通讯作者：
Sofia Trommlerová
影响因子：
7.7
作者：
Smith LM;Lévesque LE;Kaufman JS;Strumpf EC
通讯作者：
Strumpf EC
影响因子：
3.3
作者：
Oldenburg CE;Moscoe E;Bärnighausen T
通讯作者：
Bärnighausen T
影响因子：
2.4
作者：
Law, Amy;McCoy, Mark;Landsman-Blumberg, Pamela
通讯作者：
Landsman-Blumberg, Pamela