Long S H, Marquis M S
RAND, Washington, DC 20005, USA.
Am J Public Health. 1998 Mar;88(3):371-6. doi: 10.2105/ajph.88.3.371.
This is a study of the effects on prenatal care and birth outcomes of Florida's July 1989 expansion in the Medicaid income eligibility threshold for pregnant women.
Concurrent and longitudinal comparisons were performed with matched birth and death certificates, hospital discharge data, Medicaid eligibility records, and records from county health departments for women giving birth from July 1988 to June 1989 (n = 56,101) or in calendar year 1991 (n = 78,421). Measures included amount and timing of prenatal care and rates of low birthweight and infant deaths.
The Medicaid expansion led to greater access and improved birth outcomes. For example, the rate of low-birthweight infants among low-income women without private insurance fell from 67.9 to 61.8 per 1000, while it remained unchanged for low-income women with private insurance. Women in the expansion group who used county health departments had fewer low-birthweight infants than those using other delivery systems.
The benefits from the Florida expansion appear to be greater than those reported for other states. The role of the public health delivery system may account for some of Florida's success.
本研究旨在探讨1989年7月佛罗里达州提高孕妇医疗补助收入资格门槛对产前护理及分娩结局的影响。
利用匹配的出生与死亡证明、医院出院数据、医疗补助资格记录以及县卫生部门的记录，对1988年7月至1989年6月分娩的妇女（n = 56,101）或1991历年分娩的妇女（n = 78,421）进行同期和纵向比较。测量指标包括产前护理的数量和时间以及低体重儿发生率和婴儿死亡率。
医疗补助扩大带来了更多的就医机会并改善了分娩结局。例如，无私人保险的低收入妇女中低体重儿发生率从每1000例67.9例降至61.8例，而有私人保险的低收入妇女这一发生率保持不变。使用县卫生部门服务的扩大组妇女比使用其他分娩系统的妇女低体重儿更少。
佛罗里达州扩大医疗补助带来的益处似乎大于其他州所报告的情况。公共卫生服务系统的作用或许是佛罗里达州取得成功的部分原因。
