Lindrooth Richard C, McCullough Jeffrey S
Department of Health Administration and Policy, Center for Health Economic and Policy Studies, Medical University of South Carolina, Charleston, SC 29425, USA.
Womens Health Issues. 2007 Mar-Apr;17(2):66-74. doi: 10.1016/j.whi.2007.02.012.
Medicaid covers nearly 50% of all family planning services nationally. Between 1994 and 2001, 11 states implemented demonstration programs that expand coverage of family planning beyond the federally mandated minimum coverage levels.
We estimate the effect of income- and postpartum-based eligibility expansions on birth rates using states that did not expand coverage as a control for states that did expand coverage. Our data span 1991-2001 and include all 50 states. We also estimate net expansion costs from societal and state perspectives for 5 expansions that published incremental expansion costs.
We find that Medicaid eligibility expansions lowered average annual birth rates in all states. Birth rates were reduced on average by 1.95 points in income-based expansions and by 0.87 points in postpartum-based expansions. The cost offset of maternal and child health expenditures of the expansions exceed program costs in all states but California. This result is likely because the objectives and scope of the California program goes beyond just unplanned births, which makes the program cost higher relative to the reduction in births.
Both income- and postpartum-based family planning expansions either yield financial benefits or, at the very least, are cost neutral from the perspective of state governments. Income-based expansions are significantly more effective because eligibility is not limited to only postpartum women. The experience of these early family planning expansions should be a guide for other states considering family planning benefit expansions. From the national perspective, 4 out of 5 programs were cost neutral, although California had significantly higher costs. From the state's perspective, all of the expansions were either budget neutral or yielded a net cost savings.
在全国范围内，医疗补助计划覆盖了近50%的所有计划生育服务。1994年至2001年间，11个州实施了示范项目，将计划生育的覆盖范围扩大到联邦规定的最低覆盖水平之上。
我们以未扩大覆盖范围的州作为扩大覆盖范围州的对照，估计基于收入和产后资格扩大对出生率的影响。我们的数据涵盖1991年至2001年，包括所有50个州。我们还从社会和州的角度估计了5次扩大覆盖范围的净扩大成本，这些扩大覆盖范围公布了增量扩大成本。
我们发现医疗补助资格的扩大降低了所有州的平均年出生率。基于收入的扩大覆盖范围使出生率平均降低了1.95个百分点，基于产后的扩大覆盖范围使出生率平均降低了0.87个百分点。除加利福尼亚州外，所有州扩大覆盖范围所带来的母婴健康支出成本抵消超过了项目成本。这一结果可能是因为加利福尼亚州项目的目标和范围不仅仅局限于意外怀孕生育，这使得该项目成本相对于生育减少而言更高。
基于收入和产后的计划生育扩大覆盖范围要么产生经济效益，或者至少从州政府的角度来看是成本中性的。基于收入的扩大覆盖范围显著更有效，因为资格不限于产后妇女。这些早期计划生育扩大覆盖范围的经验应该为其他考虑扩大计划生育福利的州提供指导。从全国角度来看，五分之四的项目是成本中性的，尽管加利福尼亚州的成本显著更高。从州的角度来看，所有扩大覆盖范围要么是预算中性的，要么产生了净成本节约。
