Saving babies: The efficacy and cost of recent changes in the Medicaid eligibility of pregnant women
Saving babies: The efficacy and cost of recent changes in the Medicaid eligibility of pregnant women
复制标题
DOI：
10.1086/262059
复制
发表时间：
1996-12-01
影响因子：
8.2
通讯作者：
Gruber, J
中科院分区：
文献类型：
--
作者：
Currie, J;Gruber, J
美国医疗保健改革的一个关键问题是扩大医疗保险资格是否会改善健康结果。我们在 1979 年至 1992 年间孕妇医疗补助资格发生巨大变化的背景下解决这个问题。我们为这一时期每个州的医疗补助政策建立了一个详细的模拟模型，并使用该模型来估计 (1) 规则变化对怀孕时有资格享受医疗补助的妇女比例的影响；(2) 医疗补助资格变化对病毒统计汇总数据中出生结果的影响。我们有三个主要发现。首先，这些变化确实极大地提高了孕妇的医疗补助资格，但各州的比例差异很大。其次，这些变化降低了婴儿死亡率和低出生体重的发生率；我们估计，15-44 岁女性的资格提高 30% 与婴儿死亡率下降 8.5% 相关。第三，早些时候，医疗补助资格的有针对性的变化仅限于特定的低收入群体，这对出生结果的影响比更广泛地扩大对高收入水平妇女的资格的影响要大得多。我们认为，这种差异的根源在于，根据更广泛的资格变更而获得资格的个人对医疗补助保险的覆盖率要低得多。然而，即使是有针对性的改变，每挽救一个婴儿生命，医疗补助计划也要花费 84 万美元，这引发了成本效益的重要问题。
A key question for health care reform in the United States is whether expanded health insurance eligibility will lead to improvements in health outcomes. We address this question in the context of the dramatic changes in Medicaid eligibility for pregnant women that took place between 1979 and 1992. We build a detailed simulation model of each state's Medicaid policy during this era and use this model to estimate (1) the effect of changes in the rules on the fraction of women eligible for Medicaid coverage in the event of pregnancy and (2) the effect of Medicaid eligibility changes on birth outcomes in aggregate Viral Statistics data. We have three main findings. First, the changes did dramatically increase the Medicaid eligibility of pregnant women, but did so at quite differential rates across the states. Second, the changes lowered the incidence of infant mortality and low birth weight; we estimate that the 30-percentage-point increase in eligibility among 15-44-year-old women was associated with a decrease in infant mortality of 8.5 percent. Third, earlier, targeted changes in Medicaid eligibility, which were restricted to specific low-income groups, had much larger effects on birth outcomes than broader expansions of eligibility to women with higher income levels. We suggest that the source of this difference is the much lower take-up of Medicaid coverage by individuals who became eligible under the broader eligibility changes. Even the targeted changes cost the Medicaid program $840,000 per infant life saved, however, raising important issues of cost effectiveness.