Jamie R. Daw (
Laura A. Hatfield is an assistant professor in the Department of Health Care Policy at Harvard Medical School.
Health Aff (Millwood). 2017 Apr 1;36(4):598-606. doi: 10.1377/hlthaff.2016.1241.
Insurance transitions-sometimes referred to as "churn"-before and after childbirth can adversely affect the continuity and quality of care. Yet little is known about coverage patterns and changes for women giving birth in the United States. Using nationally representative survey data for the period 2005-13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100-185 percent of the poverty level. To minimize the adverse effects of coverage disruptions, states should consider policies that promote the continuity of coverage for childbearing women, particularly those with pregnancy-related Medicaid eligibility.
保险的转变——有时被称为“流失”——在分娩前后可能会对护理的连续性和质量产生不利影响。然而，对于在美国分娩的女性来说，关于覆盖范围和变化的了解甚少。利用 2005 年至 2013 年期间具有全国代表性的调查数据，我们发现分娩前后的保险转变率很高。在分娩前九个月没有保险的女性中，有一半在分娩当月获得了医疗补助或儿童健康保险计划的覆盖，但在分娩时有这种覆盖的女性中有 55%在随后的六个月内出现了覆盖缺口。与分娩后保险损失相关的风险因素包括在家不说英语、未婚、分娩时享受医疗补助或儿童健康保险计划、居住在南部地区以及家庭收入为贫困水平的 100-185%。为了将覆盖范围中断的不利影响降到最低，各州应考虑制定政策，促进生育女性的覆盖范围的连续性，特别是那些与妊娠相关的符合医疗补助条件的女性。
