Frederiksen Brittni, Dennis Emily, Liu Guodong, Leslie Doug, Salganicoff Alina, Roberts Sarah
Women's Health Policy, KFF, San Francisco, CA, United States.
Center for Applied Studies in Health Economics, Pennsylvania State College of Medicine, Hershey, PA, United States.
Contraception. 2025 Feb;142:110704. doi: 10.1016/j.contraception.2024.110704. Epub 2024 Sep 16.
To identify limitations of abortion data in national Medicaid claims files by comparing abortion counts in Medicaid claims data with state abortion estimates.
We used procedure (Current Procedural Terminology/Healthcare Common Procedure Coding System) and drug (National Drug Code) codes to identify abortion claims in 2009 and 2010 Medicaid Analytic eXtract (MAX) and 2020 Transformed Medicaid Statistical Information System Analytic File (TAF) data. We compared the number of abortions in MAX and TAF to the number of expected abortions covered by Medicaid overall and by state. Based on recent published research, we estimated expected Medicaid-covered abortions as 62% of total abortions in states using state funds to cover abortion services for Medicaid enrollees and 0.9% in states that follow Hyde restrictions.
MAX data identified 11% (38,668/345,480) of expected Medicaid-covered abortions in 2009 and 13% (44,528/330,801) of expected Medicaid-covered abortions in 2010. In 2020 TAF data, we found 25% (69,728/279,048) of the expected Medicaid-covered abortions. Among the 16 states that used state funds to cover abortions for Medicaid enrollees in 2020, the majority had <10% of expected Medicaid-covered abortions (n = 8). Three states had between 10% and 50% of expected abortions. Four states had between 51% and 75% of expected abortions. One state had insufficient data for reporting.
Abortion claims in MAX/TAF are an undercount of abortions covered by Medicaid, and this undercount varies across states. Variation in reporting across states and across time likely introduces bias into research trying to use MAX/TAF abortion claims across states and time. Researchers should use extreme caution when using MAX/TAF for abortion-related research.
Researchers should use caution when using the Medicaid Analytic eXtract and Transformed Medicaid Statistical Information System Analytic Files for abortion-related research questions.
通过比较医疗补助计划索赔数据中的堕胎计数与各州堕胎估计数，确定国家医疗补助计划索赔文件中堕胎数据的局限性。
我们使用程序（现行程序术语/医疗保健通用程序编码系统）和药品（国家药品编码）代码，在2009年和2010年医疗补助分析提取物（MAX）以及2020年转换后的医疗补助统计信息系统分析文件（TAF）数据中识别堕胎索赔。我们将MAX和TAF中的堕胎数量与医疗补助计划总体及各州预期涵盖的堕胎数量进行了比较。根据最近发表的研究，我们估计，在使用州资金为医疗补助计划参保人提供堕胎服务的州，预期由医疗补助计划涵盖的堕胎数量占总堕胎数的62%，而在遵循海德限制的州，这一比例为0.9%。
MAX数据识别出2009年预期由医疗补助计划涵盖的堕胎数量的11%（38,668/345,480）以及2010年预期由医疗补助计划涵盖的堕胎数量的13%（44,528/330,801）。在2020年TAF数据中，我们发现了预期由医疗补助计划涵盖的堕胎数量的25%（69,728/279,048）。在2020年使用州资金为医疗补助计划参保人提供堕胎服务的16个州中，大多数州的堕胎数量占预期由医疗补助计划涵盖的堕胎数量的比例不到10%（n = 8）。三个州的堕胎数量占预期堕胎数量的比例在10%至50%之间。四个州的堕胎数量占预期堕胎数量的比例在51%至75%之间。一个州的数据不足以进行报告。
MAX/TAF中的堕胎索赔数低于医疗补助计划涵盖的堕胎数，且这种低估在各州之间存在差异。各州之间以及不同时间的报告差异可能会给试图跨州和跨时间使用MAX/TAF堕胎索赔的研究带来偏差。研究人员在使用MAX/TAF进行与堕胎相关的研究时应极其谨慎。
研究人员在使用医疗补助分析提取物和转换后的医疗补助统计信息系统分析文件解决与堕胎相关的研究问题时应谨慎。
