医疗补助初级保健费率提高对医疗补助保险妇女产前保健利用的影响。
Effect of the Medicaid Primary Care Rate Increase on Prenatal Care Utilization Among Medicaid-Insured Women.
机构信息
Department of Healthcare Policy and Research, Weill Cornell Medical College, 402 E. 67th Street, New York, NY, 10065, USA.
Andrew Young School of Policy Studies, Department of Economics, Georgia State University, 14 Marietta Street NW, 30303, Atlanta, GA, USA.
出版信息
Matern Child Health J. 2019 Nov;23(11):1564-1572. doi: 10.1007/s10995-019-02804-6.
OBJECTIVE
To evaluate the effect of the 2013-2014 ACA Medicaid Primary Care Rate Increase on Medicaid-insured women's prenatal care utilization, overall and by race and ethnicity.
METHODS
We employed a difference-in-differences design, using births data from the 2010-2014 National Vital Statistics System. Our study population included approximately 6.2 million births to Medicaid insured mothers conceived between April 2009 and March 2014. Our treatment group was births in states with large (relative to small) fee bump, defined as having Medicaid-to-Medicare fee ratio below the median of all states (0.7) in 2012. Our control group was births in states with a small fee bump. Prenatal care utilization measures included initiation of prenatal care in the first trimester and number of prenatal care visits.
RESULTS
Non-Hispanic Black women giving births in large fee bump states had 9% higher odds (95% CI 1.02, 1.17) of initiating prenatal care in the first trimester during the fee bump period, compared to small fee bump states. Prenatal care visits in this group also increased by 0.24 (95% CI 0.10, 0.39), 2.4% of the mean. A smaller increase in prenatal care visits of 0.17 (95% CI 0.00, 0.33) was found among non-Hispanic Whites. The fee bump had no impact among Hispanics or non-Hispanic women of other races.
CONCLUSIONS FOR PRACTICE
The Medicaid "fee bump" improved prenatal care utilization for non-Hispanic Black and White women. Policymakers may consider reinstating higher Medicaid reimbursements to improve access to care for disadvantaged populations.
目的
评估 2013-2014 年 ACA 医疗补助初级保健费率上调对医疗补助保险的女性产前保健利用的影响，总体上以及按种族和族裔划分。
方法
我们采用了差异中的差异设计，使用了 2010-2014 年国家生命统计系统的出生数据。我们的研究人群包括大约 620 万在 2009 年 4 月至 2014 年 3 月期间由 Medicaid 保险的母亲怀孕的出生。我们的治疗组是在有较大（相对于较小）费用增长的州出生的婴儿，这一定义为 2012 年 Medicaid 与 Medicare 费用比率低于所有州中位数（0.7）的州。我们的对照组是在费用增长较小的州出生的婴儿。产前保健利用的衡量标准包括在第一孕期开始产前保健以及产前保健访问次数。
结果
在费用增长较大的州出生的非西班牙裔黑人女性，在费用增长期间，在第一孕期开始产前保健的可能性高 9%（95%CI 1.02，1.17），与费用增长较小的州相比。该组的产前保健访问次数也增加了 0.24（95%CI 0.10，0.39），占平均值的 2.4%。非西班牙裔白人的产前保健访问量增加了较小的 0.17（95%CI 0.00，0.33）。西班牙裔或其他种族的非西班牙裔女性中，费用增长没有影响。
结论
医疗补助“费用增长”提高了非西班牙裔黑人和白人女性的产前保健利用率。政策制定者可能会考虑恢复更高的 Medicaid 报销，以改善弱势人群的获得护理的机会。
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