Atkins Danielle N, Held Mary L, Lindley Lisa C
Department of Health Management and Informatics, University of Central Florida, Orlando, Florida.
College of Social Work, University of Tennessee, Knoxville, Nashville, Tennessee.
Public Health Nurs. 2018 Nov;35(6):459-465. doi: 10.1111/phn.12524. Epub 2018 Jun 10.
The objective of this study was to investigate the effect of expanding Medicaid health insurance coverage for unauthorized women on prenatal care utilization.
A natural experiment design was used. We examined the prenatal care utilization of 20,876 unauthorized women from Nebraska, which expanded Medicaid coverage for unauthorized women, and South Carolina, which has never expanded coverage.
Measurements of prenatal care utilization included adequate prenatal care using the Kotelchuck Index and the number of prenatal care visits. The policy independent variable of interest was an interaction between the policy years (2007-2009) and Nebraska residence. Demographic characteristics were included as covariates. Analysis entailed a difference-in-difference approach to compare prenatal care utilization by state, both before and after legislation was passed to fund care among unauthorized women in Nebraska.
Women with insurance coverage were more likely to utilize prenatal services. Unauthorized women living in Nebraska during Medicaid expansion were 28% more likely to receive adequate prenatal care (OR = 1.28, p < 0.01) and had about one more prenatal care visit (IRR = 1.05, p < 0.01) than women who did not have expanded Medicaid coverage.
Findings have important public health policy implications to support improved birth outcomes among native-born infants of unauthorized women.
本研究的目的是调查扩大医疗补助健康保险覆盖范围对未授权女性产前护理利用情况的影响。
采用自然实验设计。我们考察了来自内布拉斯加州（该州扩大了对未授权女性的医疗补助覆盖范围）和南卡罗来纳州（该州从未扩大覆盖范围）的20876名未授权女性的产前护理利用情况。
产前护理利用情况的测量指标包括使用科特尔查克指数衡量的充分产前护理以及产前护理就诊次数。感兴趣的政策自变量是政策年份（2007 - 2009年）与内布拉斯加州居民身份之间的交互作用。人口统计学特征作为协变量纳入。分析采用差异中的差异方法，以比较在内布拉斯加州通过为未授权女性提供护理资金的立法前后，各州的产前护理利用情况。
有保险覆盖的女性更有可能利用产前服务。在医疗补助扩大期间居住在内布拉斯加州的未授权女性比没有扩大医疗补助覆盖范围的女性接受充分产前护理的可能性高28%（比值比 = 1.28，p < 0.01），并且产前护理就诊次数多约一次（发病率比值 = 1.05，p < 0.01）。
研究结果对支持改善未授权女性本国出生婴儿的出生结局具有重要的公共卫生政策意义。
