The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review.
The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review.
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DOI：
10.1377/hlthaff.2021.01150
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发表时间：
2022-01-01
期刊：
影响因子：
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通讯作者：
Daw, Jamie R
中科院分区：
文献类型：
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作者：
Bellerose, Meghan;Collin, Lauren;Daw, Jamie R
《平价医疗法案》（ACA）扩大了低收入成年人的医疗补助资格，无论他们是否怀孕或是否为人父母。各州采用这一扩大方案的不同，为研究扩大公共保险对保险覆盖面、医疗保健使用和孕前、怀孕和产后健康结果的影响提供了一个自然的实验。我们对该主题的相关文献进行了系统综述，分析了2014年1月至2021年4月期间发表的24项研究。我们发现ACA医疗补助计划的扩张增加了孕前和产后医疗补助计划的覆盖率，而非保险、私人保险覆盖率和保险流失率相应下降。尽管一些研究报告称，在产前和产后就诊率、孕产妇死亡率、低出生体重和早产率方面，种族和民族差异有所减少，但有限的证据表明，扩大医疗补助计划增加了围产期医疗保健的使用或总体上改善了婴儿出生结局。需要对孕前和产后结果进行更强有力的数据收集，并有足够的样本量按种族和民族进行分层，以评估ACA和新出现的医疗补助政策变化（如产后医疗补助延长）的全面影响。
The Affordable Care Act (ACA) Medicaid expansion increased Medicaid eligibility for low-income adults regardless of their pregnancy or parental status. Variation in states' adoption of this expansion created a natural experiment to study the effects of expanding public insurance on insurance coverage, health care use, and health outcomes during preconception, pregnancy, and postpartum. We conducted a systematic review of relevant literature on this topic, analyzing twenty-four studies published between January 2014 and April 2021. We found that the ACA Medicaid expansion increased preconception and postpartum Medicaid coverage with corresponding declines in uninsurance, private insurance coverage, and insurance churn. There was limited evidence that Medicaid expansion increased perinatal health care use or improved infant birth outcomes overall, although some studies reported reduced racial and ethnic disparities in rates of prenatal and postpartum visit attendance, maternal mortality, low birthweight, and preterm births. Stronger data collection on preconception and postpartum outcomes with sufficient sample sizes to stratify by race and ethnicity is needed to assess the full impact of the ACA and emerging Medicaid policy changes, such as the postpartum Medicaid extension.