Impact of Medicaid Expansion on Reported Incidents of Child Neglect and Physical Abuse
Impact of Medicaid Expansion on Reported Incidents of Child Neglect and Physical Abuse
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DOI：
10.1016/j.amepre.2021.06.010
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发表时间：
2021-12-15
影响因子：
5.5
通讯作者：
Letourneau, Elizabeth J.
中科院分区：
文献类型：
--
作者：
McGinty, Emma E.;Nair, Reshmi;Letourneau, Elizabeth J.
简介：美国平价医疗法案医疗补助计划的扩展，允许各州从2014年开始将医疗补助计划的覆盖范围扩大到低收入成年人，减少了儿童忽视和身体虐待的风险因素，包括父母的经济不安全感，物质使用和未经治疗的精神疾病。本研究探讨了医疗补助扩张与每10万名0-5岁、6 - 12岁和13-17岁儿童的总体、首次和重复儿童忽视和身体虐待事件报告率之间的关联。2008-2018年全国虐待儿童和虐待儿童数据系统进行了分析，差异方法，说明了政策执行在不同时间的交错。由于2015年至2017年扩大医疗补助的6个州的非平行前期趋势的证据，主要分析包括2014年新扩大医疗补助的20个州和2008年至2018年没有扩大医疗补助的18个州。分析于2020- 2021年进行。结果：医疗补助扩展状态与13.4%的减少相关（95% CI=-24.2，-9.6），14.8%（95% CI=-26.4，-1.4）和16.0%与对照州相比，每100，000名0-5岁、6-12岁和13-17岁儿童每州每年的平均儿童忽视报告率为（-27.6，-2.6）。扩张与17.3%的（95% CI=-28.9，-3.8）0-5岁儿童首次忽视报告率降低，6-12岁和13-17岁儿童重复忽视报告率分别降低18.7%（95% CI =-29.3，-1.6）和18.7%（95% CI=-32.5，-2.1）。有没有统计学显着的关联医疗补助的扩张和身体虐待的比率在任何年龄组的儿童之间。结论：保险的低收入成年人的扩张可能会减少儿童忽视。(C)2021年美国预防医学杂志。爱思唯尔公司出版All rights reserved.
Introduction: The U.S. Affordable Care Act Medicaid expansion, which allowed states to expand Medicaid coverage to low-income adults beginning in 2014, has reduced the risk factors for child neglect and physical abuse, including parental financial insecurity, substance use, and untreated mental illness. This study examines the associations between Medicaid expansion and the rates of overall, first-time, and repeat reports of child neglect and physical abuse incidents per 100,000 children aged 0-5, 6 12, and 13-17 years.Methods: The 2008-2018 National Child Abuse and Neglect Data System was analyzed using an extension of the difference-in-differences approach that accounts for staggered policy implementation across time. Owing to evidence of nonparallel preperiod trends in the 6 states that expanded Medicaid from 2015 to 2017, the main analyses included 20 states that newly expanded Medicaid in 2014 and 18 states that did not expand Medicaid from 2008 to 2018. Analyses were conducted in 2020-2021.Results: Medicaid expansion states were associated with reductions of 13.4% (95% CI= -24.2, -9.6), 14.8% (95% CI= -26.4, -1.4), and 16.0% (-27.6, -2.6) in the average rate of child neglect reports per 100,000 children aged 0-5, 6-12, and 13-17 years, per state-year, relative to control states. Expansion was associated with a 17.3% (95% CI= -28.9, -3.8) reduction in the rate of firsttime neglect reports among children aged 0-5 years and with 16.6% (95% CI= -29.3, -1.6) and 18.7% (95% CI= -32.5, -2.1) reductions in the rates of repeat neglect reports among children aged 6-12 and 13-17 years, respectively. There were no statistically significant associations between Medicaid expansion and the rates of physical abuse among children in any age group.Conclusions: Insurance expansions for low-income adults may reduce child neglect. (C) 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.