Using Deliberative and Qualitative Methods to Recommend Revisions to the Medicaid Sterilization Waiting Period
Using Deliberative and Qualitative Methods to Recommend Revisions to the Medicaid Sterilization Waiting Period
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DOI：
10.1016/j.whi.2020.04.001
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发表时间：
2020-07-01
影响因子：
3.2
通讯作者：
Cheney, Ann M.
中科院分区：
文献类型：
--
作者：
Batra, Priya;Rodriguez, Katheryn;Cheney, Ann M.
背景资料：在美国，四分之一的妇女使用绝育来避孕，这是医疗补助妇女的首选避孕方法。美国强制绝育做法的历史导致联邦对医疗补助绝育的同意作出规定（包括规定的等待期）;这项规定可能成为医疗补助保险妇女绝育的障碍。本研究的目的是制定一个修订后的模式，医疗补助绝育政策接地的经验，妇女受现行regulation.Methods：这项前瞻性研究采用了深入的访谈与32名医疗保险的妇女谁已经获得或试图获得绝育，以引出关于医疗补助等待期的建议。审议的方法（包括20个关键的社区利益相关者的规划单元）被用来评估妇女的建议，并提出了一个修订后的政策，根据Medicaid.Results绝育：深入访谈数据表明，妇女往往不知道30天的等待期在知情同意之前绝育。一旦得知这项政策，妇女们就认为医疗补助等待期是“不公平的”，因为它并不适用于所有妇女。在审议了妇女提出的修改政策的建议后，主要利益攸关方达成共识，同意以改进的同意程序取代目前的等待期政策，承认强制绝育的历史问题。参与者不能赞同完全取消等待期没有证据表明，卫生系统已经从强制性sterilization practice.Conclusions转移：使用审议的方法和妇女与医疗补助保险的建议，社区利益相关者建议制定一个修订的医疗补助绝育同意政策，承认这一程序的历史背景。(C)2020年雅各布妇女健康研究所。爱思唯尔公司出版
Background: Sterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations.Methods: This prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid.Results: In-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as "unfair," because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices.Conclusions: Using deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure. (C) 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc.