Medicaid Expansion in Oregon: Access and Health Outcomes for Women and Infants

摘要 早期干预以识别和治疗慢性病并改变妇女的行为危险因素 生育年龄有可能显著降低其发病率和死亡率，并改善其 妊娠结局。缺乏医疗保险一直是早期干预和预防的主要障碍。 低收入育龄妇女的护理。然而，2014年医疗补助计划的扩大 患者保护和平价医疗法案(ACA)将使数百万新的低收入女性有资格获得 医疗补助和预防性健康服务。一个集成的数据系统是评估这一影响的关键 扩大育龄妇女及其婴儿的健康。使用该数据系统的研究将 为未来的计划规划提供信息，并确定最佳实践和最需要的领域。我们建议创建 将俄勒冈州医疗补助数据与出生和死亡证明以及医院联系起来的集成数据系统 出院数据。此外，我们将包括其他人无法获得的医疗补助服务质量数据 各州。这项拟议的研究是俄勒冈州立大学和俄勒冈健康中心合作进行的 权威。俄勒冈州是进行这项拟议研究的理想州，因为俄勒冈州正在进行这项研究 到医疗补助医疗保健提供改革和州领导人承诺跨部门合作 和计划以确保这个项目的成功。该项目还得到了国家主要利益攸关方的支持 妇幼卫生和妇女健康。这项提议的具体目的是1)开展一项研究 议程，与主要利益攸关方合作，评估扩大医疗补助对 俄勒冈州符合医疗补助条件的育龄妇女、母亲和婴儿；2)将俄勒冈州的医疗补助数据链接到 全州范围的数据集，包括(但不限于)活产、胎儿 死亡、婴儿死亡和出院数据，从2008年开始，一直持续到2016年 3)进行有计划的分析并传播研究结果。研究议程将 包括评估医疗补助扩大对医疗补助登记的影响的关键研究问题，以及 低收入妇女获得护理的机会；参加医疗补助的妇女和婴儿对服务的利用； 这些妇女的一般健康行为、风险和结局；以及妊娠并发症和不良出生 结果。我们还将衡量医疗补助扩大后仍然存在的差距，以便为以下战略提供信息 在持续的基础上缩小这些差距。我们将使用这些分析的结果来构建模拟 这将这项研究的发现扩展到对其他领域的政策制定者和利益相关者的影响和教训 正在扩大医疗补助的州。这些分析和模拟的结果将为 支持俄勒冈州和全美医疗改革努力的信息，以减少公共卫生 增加包括怀孕和婴儿在内的育龄妇女的负担和改善人口健康 健康结果。

Abstract Early intervention to identify and treat chronic disease and modify behavioral risk factors among women of reproductive age has the potential to significantly reduce their morbidity and mortality and improve their pregnancy outcomes. Lack of health insurance has been a major barrier to early intervention and preventive care among low-income women of reproductive age. However, the 2014 expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) will make millions of low-income women newly eligible for Medicaid and preventive health services. An integrated data system is essential to evaluate the impact of this expansion on the health of women of reproductive age and their infants. Research using this data system will inform future program planning and identify best practices and areas of greatest need. We propose to create an integrated data system that links Oregon Medicaid data with birth and death certificates and hospital discharge data. Further, we will include data on the quality of Medicaid services that are not available to other states. The proposed study is a collaborative effort between Oregon State University and the Oregon Health Authority. Oregon is an ideal state in which to conduct the proposed study because of its ongoing commitment to Medicaid health care delivery reform and the commitment of state leaders to collaborate across divisions and programs to ensure this project's success. The project also has the support of key state stakeholders in maternal and child health and women's health. The specific aims of the proposal are to1) develop a research agenda, in collaboration with key stakeholders, to evaluate the expansion of Medicaid on the health of Medicaid-eligible women of reproductive age, mothers, and infants in Oregon; 2) link Oregon Medicaid data for female enrollees ages 15-44 and their infants to statewide datasets, including (but not limited to) live birth, fetal death, infant death, and hospital discharge data, beginning with 2008 and continuing until 2016, as data become available; and 3) conduct planned analyses and disseminate findings. The research agenda will include key research questions that assess the effect of Medicaid expansion on Medicaid enrollment and access to care for low-income women; utilization of services by women and infants enrolled in Medicaid; general health behaviors, risks, and outcomes for these women; and pregnancy complications and poor birth outcomes. We will also measure disparities that remain after Medicaid expansion, to inform strategies to mitigate those disparities on an ongoing basis. We will use results of these analyses to construct simulations that extend this study's findings into implications and lessons for policy makers and stakeholders in other states that are expanding Medicaid. Results of these analyses and simulations will provide valuable information to support health reform efforts, both in Oregon and across the U.S, to reduce the public health burden and improve population health among women of reproductive age, including pregnancy and infant health outcomes.