Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review.
Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review.
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DOI：
10.1001/jamanetworkopen.2023.16536
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发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Balk, Ethan M.
中科院分区：
文献类型：
--
作者：
Saldanha, Ian J.;Adam, Gaelen P.;Kanaan, Ghid;Zahradnik, Michael L.;Steele, Dale W.;Chen, Kenneth K.;Peahl, Alex F.;Danilack-Fekete, Valery A.;Stuebe, Alison M.;Balk, Ethan M.
这篇系统性综述评估了美国健康保险覆盖范围的扩大或改善与产后结局之间的关联。医疗保险覆盖范围的扩大或获得医疗保健的改善是否与产后1年内的产后医疗保健利用和产妇结局相关？该系统性综述包括28项大部分为中等偏倚风险的非随机研究。在一些研究中，基于中等强度的证据，观察到更全面的保险和更多的产后访视之间的关联;对于其他类型的产后保健结果，与保险覆盖范围改善相关的证据强度较低。这些研究结果表明，所确定的证据充其量是中等强度;未来的研究应评估更全面或更广泛的健康保险对产后期及以后健康结果的影响。在美国，大约有一半的产后妇女没有接受任何常规的产后保健。目前，联邦医疗补助计划对孕妇的覆盖范围在产后第60天的最后一天之后失效，这限制了长期的产后护理。评估健康保险覆盖范围的扩大或获得卫生保健的改善是否与产后1年内的产后卫生保健利用和孕产妇结局相关。检索了Medline、Embase、CENTRAL、CINAHL和ClinicalTrials.gov，以查找从开始到2022年11月16日的美国研究。扫描相关系统性综述的参考文献列表，寻找潜在合格的研究。使用科克伦偏倚风险工具和非随机干预研究偏倚风险工具中的问题评估偏倚风险。使用美国医疗保健研究和质量方法指南评估证据强度（SoE）。共筛选了25973篇引文，纳入了28项主要为中度偏倚风险的非随机研究（3423781例受试者），这些研究涉及保险类型（4项研究）、使保险更全面的政策变化（13项研究）、使保险不那么全面的政策变化（2项研究）和医疗补助扩展（9项研究）。中度SoE的研究结果表明，更全面的关联可能与产后访视的更多参与有关。低SOE的调查结果表明，更全面的保险和更少的可预防的再入院和急诊室就诊之间可能存在关联。这项系统性综述的结果表明，评估保险覆盖范围和产后访视出勤率和计划外护理利用率的证据充其量是中等程度的SOE。未来的研究应该评估与更全面的保险覆盖范围相关的临床结果。
This systematic review evaluates the association between health insurance coverage extensions or improvements and postpartum outcomes in the US. Are health insurance coverage extension or improvements in access to health care associated with postpartum health care utilization and maternal outcomes within 1 year post partum? This systematic review included 28 mostly moderate-risk-of-bias nonrandomized studies. An association between more comprehensive insurance and greater attendance at postpartum visits was observed in some studies based on a moderate strength of evidence; for other types of postpartum health care outcomes, the strength of evidence for association with insurance coverage improvement was low. These findings suggest that evidence identified is, at best, of moderate strength; future research should evaluate the impact of more comprehensive or extended health insurance on health outcomes in the postpartum period and beyond. Approximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care. To assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum. Medline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide. A total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits. The findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
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2.3
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