Dubay L C, Kenney G M, Norton S A, Cohen B C
Health Policy Center, Urban Institute, Washington, DC 20037, USA.
Milbank Q. 1995;73(4):535-63.
Concern about high infant mortality and morbidity in the United States, combined with the erosion of private insurance coverage, sparked major expansions in the Medicaid program in the 1980s. This study examines how the Medicaid expansions for pregnant women affected access to prenatal care for low-income women through case studies conducted in four states early in 1991. Despite the significantly greater share of births covered by Medicaid in the period 1986 to 1991, the timely initiation of prenatal care improved in only one state. Although prenatal services increased in some areas, significant problems persisted in others. The growth in capacity of the prenatal care system was greatest when state and local policies designed to increase supply were also instituted. While the Medicaid expansions eliminated significant barriers to prenatal care for low-income women, other policies that have been designed to reduce the remaining barriers may be necessary in order significantly to expand access to prenatal care and to improve birth outcomes.
对美国婴儿高死亡率和高发病率的担忧，再加上私人保险覆盖范围的缩减，引发了20世纪80年代医疗补助计划的重大扩张。本研究通过1991年初在四个州开展的案例研究，考察了针对孕妇的医疗补助计划扩张如何影响低收入女性获得产前护理的情况。尽管在1986年至1991年期间，医疗补助计划覆盖的分娩比例显著增加，但只有一个州的产前护理及时启动情况有所改善。虽然一些地区的产前服务有所增加，但其他地区仍存在重大问题。当旨在增加供给的州和地方政策也得到实施时，产前护理系统的能力增长最大。虽然医疗补助计划的扩张消除了低收入女性获得产前护理的重大障碍，但可能需要其他旨在减少剩余障碍的政策，以便显著扩大产前护理的可及性并改善分娩结局。
