Department of Sociology, University of Cincinnati, Cincinnati, Ohio.
Ibis Reproductive Health, Cambridge, Massachusetts.
Womens Health Issues. 2015 Mar-Apr;25(2):91-6. doi: 10.1016/j.whi.2014.11.002. Epub 2015 Jan 24.
To explore how Massachusetts' 2006 health insurance reforms affected access to sexual and reproductive health (SRH) services for young adults.
We conducted 11 focus group discussions across Massachusetts with 89 women and men aged 18 to 26 in 2009.
Most young adults' primary interaction with the health system was for contraceptive and other SRH services, although they knew little about these services. Overall, health insurance literacy was low. Parents were primary decision makers in health insurance choices or assisted their adult children in choosing a plan. Ten percent of our sample was uninsured at the time of the discussion; a lack of knowledge about provisions in Chapter 58 rather than calculated risk analysis characterized periods of uninsurance. The dynamics of being transitionally uninsured, moving between health plans, and moving from a location defined by insurance companies as the coverage area limited consistent access to contraception. Notably, staying on parents' insurance through extended dependency, a provision unique to the post-reform context, had implications for confidentiality and access.
Young adults' access to and utilization of contraceptive services in the post-reform period were challenged by unanticipated barriers related to information and privacy. The experience in Massachusetts offers instructive lessons for the implementation of national health care reform. Young adult-targeted efforts should address the challenges of health service utilization unique to this population.
探讨马萨诸塞州 2006 年医疗保险改革对年轻人获得性健康和生殖健康（SRH）服务的影响。
我们于 2009 年在马萨诸塞州进行了 11 次焦点小组讨论，共有 89 名 18 至 26 岁的女性和男性参加。
大多数年轻人与医疗系统的主要互动是为了获得避孕和其他 SRH 服务，尽管他们对这些服务知之甚少。总的来说，健康保险知识水平较低。父母是健康保险选择的主要决策者，或协助他们的成年子女选择计划。我们样本中的 10%在讨论时没有保险；对第 58 章规定的了解不足，而不是对风险的计算分析，是导致无保险的原因。过渡性无保险、在健康计划之间转换以及从保险公司定义的保险覆盖范围内移动的动态，限制了对避孕措施的持续获得。值得注意的是，通过延长依赖期留在父母的保险范围内，这是改革后独有的规定，对保密性和可及性都有影响。
在改革后的时期，年轻人获得和利用避孕服务的机会受到与信息和隐私相关的意外障碍的挑战。马萨诸塞州的经验为国家医疗改革的实施提供了有益的教训。针对年轻人群体的努力应解决该人群特有的医疗服务利用挑战。
