Medicaid expansions, preconception insurance, and unintended pregnancy among new parents
Medicaid expansions, preconception insurance, and unintended pregnancy among new parents
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DOI：
10.1111/1475-6773.13662
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发表时间：
2021-04-27
影响因子：
3.4
通讯作者：
Cohen, Jessica L.
中科院分区：
文献类型：
--
作者：
Geiger, Caroline K.;Sommers, Benjamin D.;Cohen, Jessica L.
目的评估医疗补助资格最近的变化与首次怀孕父母中不良生育结局的风险因素、怀孕意向、医疗保健使用和风险因素之间的关系。数据来源：这项研究使用了来自国家怀孕风险评估监测系统(2006-2017)的个人水平的数据，该系统调查了最近在美国分娩的人在怀孕前、怀孕期间和怀孕后的经历。研究设计结果包括怀孕前保险状况、怀孕意图、账单压力、早期产前护理以及高血压和糖尿病的诊断。结果根据衡量医疗补助慷慨程度的指数进行回归，该指数捕捉每个州和年份基于州收入资格门槛有资格获得医疗补助的女性个人的比例。数据收集/提取方法样本包括所有20-44岁的个人，他们在2009年至2017年第一次活着出生。主要研究结果在所有首次为人父母的人中，医疗补助慷慨程度每增加10个百分点，怀孕前一个月的所有保险覆盖范围增加0.7%(P=0.017)，医疗补助覆盖范围增加1.5%(P<；0.001)。我们还观察到，在高中或高中以下的个人中，保险覆盖范围和早期产前护理显著增加，账单和意外怀孕带来的压力下降。结论增加对无子女成年人的医疗补助慷慨，有可能提高怀孕前关键时期的保险覆盖范围，并有助于改善首次为人父母的产妇结局。
Objective To assess the relationship between recent changes in Medicaid eligibility and preconception insurance coverage, pregnancy intention, health care use, and risk factors for poor birth outcomes among first-time parents.Data Source This study used individual-level data from the national Pregnancy Risk Assessment Monitoring System (2006-2017), which surveys individuals who recently gave birth in the United States on their experiences before, during, and after pregnancy.Study Design Outcomes included preconception insurance status, pregnancy intention, stress from bills, early prenatal care, and diagnoses of high blood pressure and diabetes. Outcomes were regressed on an index measuring Medicaid generosity, which captures the fraction of female-identifying individuals who would be eligible for Medicaid based on state income eligibility thresholds, in each state and year.Data Collection/Extraction Methods The sample included all individuals aged 20-44 with a first live birth in 2009-2017.Principal Findings Among all first-time parents, a 10-percentage point (ppt) increase in Medicaid generosity was associated with a 0.7 ppt increase (P = 0.017) in any insurance coverage and a 1.5 ppt increase (P < 0.001) in Medicaid coverage in the month before pregnancy. We also observed significant increases in insurance coverage and early prenatal care and declines in stress from bills and unintended pregnancies among individuals with a high-school degree or less.Conclusions Increasing Medicaid generosity for childless adults has the potential to improve insurance coverage in the critical period before pregnancy and help improve maternal outcomes among first-time parents.