Reducing Postpartum Health Care Disparities through Increased Insurance Coverage after Childbirth

项目总结 Steenland博士的长期职业目标是成为一名独立的政策研究员，产生证据以 改善美国的产妇健康状况。非裔美国女性比白人女性更有可能经历 严重的孕产妇发病率和死亡率。由于医疗补助覆盖了非洲人不成比例的大部分 对于怀孕期间的美国和西班牙裔妇女来说，该计划对她们的产妇健康起着至关重要的作用。 然而，许多怀孕期间接受医疗补助的妇女在产后60天就失去了保险。我们 政策制定者正在考虑减少孕产妇死亡率差距的政策选择，包括扩大 医疗补助覆盖范围从产后60天到一年。然而，这种影响增加了 关于产后医疗保健使用和健康结果的医疗补助覆盖范围尚不清楚。斯廷兰德博士将 审查扩大医疗补助在产后保险覆盖范围、医疗保健获得机会、 以及新近怀孕妇女的健康状况。她将使用来自美国社区的数据 调查和阿肯色州所有付款人索赔数据库追求以下研究目标：(1)评估 扩大医疗补助对全国产后保险覆盖范围的种族/民族差异的影响；(2) 检查扩大医疗补助对产后护理和健康结果差异的影响 阿肯色州的非裔美国人和非西班牙裔白人妇女在产后增长最多 医疗补助扩大后的保险覆盖范围。这些研究将为美国的政策提供亟需的证据 关于产后保险覆盖面扩大对医疗保健利用率和结果的影响。 这项拟议的研究建立在Steenland博士之前关于医疗补助报销影响的研究基础上 用于产后即刻长效可逆避孕对产后避孕用药和生育的影响 间隔时间。她将继续进行以下K01培训目标，为拟议的研究和她的 职业目标：(1)获得产科和产妇保健方面的培训；(2)获得家庭保健方面的培训 (3)获得卫生政策评估计量方法方面的高级培训。要实现这些目标 为了实现培训目标，斯蒂兰德博士在布朗大学组建了一个由阿迈勒·特里维迪博士领导的导师团队， 公共卫生学院卫生服务、政策和实践系教授；艾拉·威尔逊博士， 卫生服务、政策和实践部教授兼主任；David Savitz博士， 公共卫生学院流行病学系；克里斯汀·马特森博士 产科和妇科，安娜·艾泽教授 经济系主任。Steenland博士的训练将使她为实现长期的 成为一名独立调查员的职业目标，致力于减少差距和改善孕产妇 通过健康政策研究促进健康。

PROJECT SUMMARY Dr. Steenland’s long-term career goal is to become an independent policy researcher generating evidence to improve maternal health in the US. African American women are more likely than white women to experience severe maternal morbidity and mortality. As Medicaid covers a disproportionally large share of African American and Hispanic women during pregnancy, the program plays a critical role in their maternal health. However, many women covered by Medicaid during pregnancy lose coverage at 60 days postpartum. US policy makers are considering policy options to reduce disparities in maternal mortality, including extending Medicaid pregnancy coverage from 60 days to one year postpartum. However, the effect of increased Medicaid coverage on postpartum health care use and health outcomes is not known. Dr. Steenland will examine the role of Medicaid expansion on disparities in postpartum insurance coverage, health care access, and health outcomes among recently pregnant women. She will use data from the American Community Survey and the Arkansas All-Payers Claims Database to pursue the following research aims: (1) Evaluate the effect of Medicaid expansion on racial/ethnic disparities in postpartum insurance coverage nationally; (2) Examine the effect of Medicaid expansion on disparities in postpartum care and health outcomes between African American and non-Hispanic white women in Arkansas, the state with the largest gains in postpartum insurance coverage after Medicaid expansion. These studies will provide much needed evidence to US policy makers about the effect of increased postpartum insurance coverage on health care utilization and outcomes. The proposed research builds upon Dr. Steenland’s prior research on the effects of Medicaid reimbursement for immediate postpartum long-acting reversible contraception on postpartum contraceptive use and birth intervals. She will pursue the following K01 training aims to prepare her for the proposed research and for her career goals: (1) Acquire training in obstetrics and maternal health; (2) Acquire training in domestic health policy; (3) Acquire advanced training in econometric methods for health policy evaluation. To achieve these training goals, Dr. Steenland has assembled a team of mentors at Brown University, led by Dr. Amal Trivedi, Professor in the School of Public Health’s Department of Health Services, Policy, and Practice; Dr. Ira Wilson, Professor and Chair of the Department of Health Services, Policy, and Practice; Dr. David Savitz, Professor in the Department of Epidemiology in the School of Public Health; Dr. Kristen Matteson, Associate Professor of Obstetrics and Gynecology in the Department of Obstetrics and Gynecology and Dr. Anna Aizer, Professor and Chair of the Department of Economics. Dr. Steenland’s training will prepare her to achieve her long-term career goal of becoming an independent investigator working to reduce disparities and improve maternal health through health policy research.