Columbia University School of Social Work, New York, New York.
Womens Health Issues. 2020 May-Jun;30(3):147-152. doi: 10.1016/j.whi.2020.01.005. Epub 2020 Feb 26.
This study explores the effect of Medicaid expansion under the Affordable Care Act on the maternal mortality ratio in the United States.
A difference-in-differences research design was used to analyze the effect of Medicaid expansion on maternal mortality. Maternal mortality was defined with and without late maternal deaths, to substantiate the contribution of increased preconception and postpartum insurance coverage. To examine whether there was a racial difference in the effects of Medicaid expansion, models were stratified by the woman's race/ethnicity for non-Hispanic Black women, non-Hispanic White women, and Hispanic women.
Medicaid expansion was significantly associated with lower maternal mortality by 7.01 maternal deaths per 100,000 live births (p = .002) relative to nonexpansion states. When maternal mortality definitions excluded late maternal deaths, Medicaid expansion was significantly associated with a decrease in maternal mortality per 100,000 live births by 6.65 (p = .004) relative to nonexpansion states. Medicaid expansion effects were concentrated among non-Hispanic Black mothers, suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.
Although maternal mortality overall continues to increase in the United States, the maternal mortality ratio among Medicaid expansion states has increased much less compared with nonexpansion states. These results suggest that Medicaid expansion could be contributing to a relative decrease in the maternal mortality ratio in the United States. The decrease in the maternal mortality ratio is greater when maternal mortality estimates include late maternal deaths, suggesting that sustained insurance coverage after childbirth as well as improved preconception coverage could be contributing to decreasing maternal mortality.
本研究探讨《平价医疗法案》下的医疗补助扩张对美国产妇死亡率的影响。
采用差异-差异研究设计来分析医疗补助扩张对产妇死亡率的影响。采用有无晚期产妇死亡的定义来定义产妇死亡率，以证明增加孕前和产后保险覆盖范围的贡献。为了检验医疗补助扩张的效果是否存在种族差异，对非西班牙裔黑人女性、非西班牙裔白人女性和西班牙裔女性进行了按女性种族/族裔分层的模型分析。
与未扩张的州相比，医疗补助扩张与每 10 万活产产妇死亡人数减少 7.01 例（p=0.002）显著相关。当排除晚期产妇死亡的产妇死亡率定义时，与未扩张的州相比，医疗补助扩张与每 10 万活产产妇死亡人数减少 6.65 例显著相关（p=0.004）。医疗补助扩张的效果主要集中在非西班牙裔黑人母亲中，表明扩张可能有助于减少产妇死亡率方面的种族差异。
尽管美国的产妇死亡率总体上仍在继续上升，但与未扩张的州相比，医疗补助扩张州的产妇死亡率比值增长要少得多。这些结果表明，医疗补助扩张可能有助于美国产妇死亡率比值的相对下降。当产妇死亡率估计数包括晚期产妇死亡时，产妇死亡率比值的下降幅度更大，这表明产后持续的保险覆盖范围以及改善孕前覆盖范围可能有助于降低产妇死亡率。
