Oregon State University, College of Public Health and Human Sciences, United States of America.
Oregon State University, College of Public Health and Human Sciences, United States of America.
Prev Med. 2021 Feb;143:106360. doi: 10.1016/j.ypmed.2020.106360. Epub 2020 Dec 9.
Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has the potential to improve reproductive health by allowing low-income women access to healthcare before and early in pregnancy. The aim of this study was to examine the effects of Oregon's Medicaid expansion on timely and adequate prenatal care. We included live births in Oregon from 2012 to 2015 and used individually-linked birth certificate and Medicaid eligibility data. Outcomes were receipt of first trimester prenatal care and receipt of adequate prenatal care. We also assessed Medicaid enrollment one month prior to pregnancy. We estimated the overall effect of Medicaid expansion on prenatal care utilization using probit regression models. Additionally, we assessed the impact of Medicaid expansion on prenatal care utilization via pre-pregnancy Medicaid enrollment using bivariate probit models. Overall, receipt of first trimester prenatal care increased post-expansion by 1.5 percentage points (p < 0.01) after expansion. Receipt of adequate prenatal care also increased significantly post-expansion with an incremental increase of 2.8 percentage points (p < 0.001). Pre-pregnancy Medicaid enrollment increased following Medicaid expansion (β = 0.55, p < 0.001) and was associated with both timely (β = 0.48, p < 0.001) and adequate receipt of prenatal care (β = 0.14, p < 0.001). Using two years of post-ACA data we found that Medicaid expansion had significant positive associations with Medicaid enrollment prior to pregnancy, which subsequently increased receipt of timely and adequate prenatal care. Our study provides evidence that expanding Medicaid has positive effects on women's use of healthcare.
《平价医疗法案》下的医疗补助扩展计划有可能通过让低收入妇女在怀孕前和怀孕初期获得医疗保健来改善生殖健康。本研究旨在研究俄勒冈州医疗补助扩展计划对及时和充分的产前护理的影响。我们纳入了俄勒冈州 2012 年至 2015 年的活产，并使用了个体链接的出生证明和医疗补助资格数据。结果是接受第一孕期产前护理和接受充分的产前护理。我们还评估了怀孕前一个月的医疗补助登记情况。我们使用概率回归模型估计医疗补助扩展对产前护理利用的总体影响。此外，我们还通过孕前医疗补助登记评估了医疗补助扩展对产前护理利用的影响，使用二元概率回归模型。总体而言，扩张后第一孕期产前护理的接受率增加了 1.5 个百分点（p<0.01）。扩张后接受充分的产前护理也显著增加，增量为 2.8 个百分点（p<0.001）。医疗补助扩张后，孕前医疗补助登记增加（β=0.55，p<0.001），并与及时（β=0.48，p<0.001）和充分接受产前护理（β=0.14，p<0.001）相关。使用 ACA 后两年的数据，我们发现医疗补助扩展与怀孕前的医疗补助登记有显著的正相关关系，这随后增加了及时和充分的产前护理的获得。我们的研究提供了证据表明，扩大医疗补助对妇女使用医疗保健有积极影响。
