Yoon Jangho, Harvey S Marie, Luck Jeff
Department of Preventive Medicine and Biostatistics, F. Edward Hebert School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States.
Front Health Serv. 2022 Aug 17;2:942476. doi: 10.3389/frhs.2022.942476. eCollection 2022.
This study examined the effect of Medicaid expansion in Oregon under the Affordable Care Act on depression screening and treatment among pregnant and postpartum women who gave Medicaid-financed births.
Oregon birth certificates were linked to Medicaid enrollment and claims records for 2011-2016. The sample included a policy group of 1,368 women ( = 2,831) who gave births covered by pregnancy-only Medicaid in the pre-expansion period (before 2014) and full-scope Medicaid in the post-expansion period, and the comparison group of 2,229 women ( = 4,580) who gave births covered by full-scope Medicaid in both pre- and post-expansion periods. Outcomes included indicators for depression screening, psychotherapy, pharmacotherapy, and combined psychotherapy-pharmacotherapy, separately for the first, second, and third trimesters, and 2 and 6 months postpartum. This study utilized a difference-in-differences approach that compared pre-post change in an outcome for the policy group to a counterfactual pre-post change from the comparison group.
Medicaid expansion led to a 3.64%-point increase in the rate of depression screening 6 months postpartum, 3.28%-point increase in the rate of psychotherapy 6 months postpartum, and 2.3 and 1%-point increases in the rates of pharmacotherapy and combined treatment in the first trimester, respectively. The relationships were driven by disproportionate gains among non-Hispanic whites and urban residents.
Expanding Medicaid eligibility may improve depression screening and treatment among low-income women early in pregnancy and/or beyond the usual two-month postpartum period. However, it does not necessarily reduce racial/ethnic and regional gaps in depression screening and treatment.
本研究探讨了《平价医疗法案》下俄勒冈州医疗补助扩大计划对接受医疗补助分娩的孕妇及产后妇女抑郁症筛查和治疗的影响。
将俄勒冈州的出生证明与2011 - 2016年的医疗补助登记及理赔记录相链接。样本包括一个政策组，共1368名妇女（n = 2831），她们在医保扩大计划实施前（2014年之前）分娩时仅享受孕期医疗补助，在医保扩大计划实施后享受全面医疗补助；以及一个对照组，共2229名妇女（n = 4580），她们在医保扩大计划实施前后分娩时均享受全面医疗补助。研究结果包括抑郁症筛查、心理治疗、药物治疗以及心理治疗与药物治疗相结合的指标，分别针对孕早期、孕中期、孕晚期以及产后2个月和6个月。本研究采用了差异中的差异方法，将政策组结果的前后变化与对照组的反事实前后变化进行比较。
医疗补助扩大计划使产后6个月抑郁症筛查率提高了3.64个百分点，产后6个月心理治疗率提高了3.28个百分点，孕早期药物治疗率和联合治疗率分别提高了2.3个和1个百分点。这些关系主要由非西班牙裔白人及城市居民的显著增加所驱动。
扩大医疗补助资格可能会改善低收入妇女在孕早期和/或产后通常的两个月之后的抑郁症筛查和治疗。然而，这并不一定会缩小抑郁症筛查和治疗在种族/民族及地区方面的差距。
