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Deng S, Renaud S, Bennett KJ. Who is your prenatal care provider? An algorithm to identify the predominant prenatal care provider with claims data. BMC Health Serv Res 2024; 24:665. [PMID: 38802871 PMCID: PMC11131320 DOI: 10.1186/s12913-024-11080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Using claims data to identify a predominant prenatal care (PNC) provider is not always straightforward, but it is essential for assessing access, cost, and outcomes. Previous algorithms applied plurality (providing the most visits) and majority (providing majority of visits) to identify the predominant provider in primary care setting, but they lacked visit sequence information. This study proposes an algorithm that includes both PNC frequency and sequence information to identify the predominant provider and estimates the percentage of identified predominant providers. Additionally, differences in travel distances to the predominant and nearest provider are compared. METHODS The dataset used for this study consisted of 108,441 live births and 2,155,076 associated South Carolina Medicaid claims from 2015-2018. Analysis focused on patients who were continuously enrolled throughout their pregnancy and had any PNC visit, resulting in 32,609 pregnancies. PNC visits were identified with diagnosis and procedure codes and specialty within the estimated gestational age. To classify PNC providers, seven subgroups were created based on PNC frequency and sequence information. The algorithm was developed by considering both the frequency and sequence information. Percentage of identified predominant providers was reported. Chi-square tests were conducted to assess whether the probability of being identified as a predominant provider for a specific subgroup differed from that of the reference group (who provided majority of all PNC). Paired t-tests were used to examine differences in travel distance. RESULTS Pregnancies in the sample had an average of 7.86 PNC visits. Fewer than 30% of the sample had an exclusive provider. By applying PNC frequency information, a predominant provider can be identified for 81% of pregnancies. After adding sequential information, a predominant provider can be identified for 92% of pregnancies. Distance was significantly longer for pregnant individuals traveling to the identified predominant provider (an average of 5 miles) than to the nearest provider. CONCLUSIONS Inclusion of PNC sequential information in the algorithm has increased the proportion of identifiable predominant providers by 11%. Applying this algorithm reveals a longer distance for pregnant individuals travelling to their predominant provider than to the nearest provider.
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Affiliation(s)
- Songyuan Deng
- University of South Carolina School of Medicine, Columbia, SC, USA.
| | - Samantha Renaud
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Kevin J Bennett
- University of South Carolina School of Medicine, Columbia, SC, USA
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2
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Fontenot J, Brigance C, Lucas R, Stoneburner A. Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States. BMC Pregnancy Childbirth 2024; 24:350. [PMID: 38720255 PMCID: PMC11080172 DOI: 10.1186/s12884-024-06535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Access to maternity care in the U.S. remains inequitable, impacting over two million women in maternity care "deserts." Living in these areas, exacerbated by hospital closures and workforce shortages, heightens the risks of pregnancy-related complications, particularly in rural regions. This study investigates travel distances and time to obstetric hospitals, emphasizing disparities faced by those in maternity care deserts and rural areas, while also exploring variances across races and ethnicities. METHODS The research adopted a retrospective secondary data analysis, utilizing the American Hospital Association and Centers for Medicaid and Medicare Provider of Services Files to classify obstetric hospitals. The study population included census tract estimates of birthing individuals sourced from the U.S. Census Bureau's 2017-2021 American Community Survey. Using ArcGIS Pro Network Analyst, drive time and distance calculations to the nearest obstetric hospital were conducted. Furthermore, Hot Spot Analysis was employed to identify areas displaying significant spatial clusters of high and low travel distances. RESULTS The mean travel distance and time to the nearest obstetric facility was 8.3 miles and 14.1 minutes. The mean travel distance for maternity care deserts and rural counties was 28.1 and 17.3 miles, respectively. While birthing people living in rural maternity care deserts had the highest average travel distance overall (33.4 miles), those living in urban maternity care deserts also experienced inequities in travel distance (25.0 miles). States with hotspots indicating significantly higher travel distances included: Montana, North Dakota, South Dakota, and Nebraska. Census tracts where the predominant race is American Indian/Alaska Native (AIAN) had the highest travel distance and time compared to those of all other predominant races/ethnicities. CONCLUSIONS Our study revealed significant disparities in obstetric hospital access, especially affecting birthing individuals in maternity care deserts, rural counties, and communities predominantly composed of AIAN individuals, resulting in extended travel distances and times. To rectify these inequities, sustained investment in the obstetric workforce and implementation of innovative programs are imperative, specifically targeting improved access in maternity care deserts as a priority area within healthcare policy and practice.
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Affiliation(s)
- Jazmin Fontenot
- Perinatal Data Center, March of Dimes, 1550 Crystal Drive Suite 1300, Arlington, VA, USA.
| | - Christina Brigance
- Perinatal Data Center, March of Dimes, 1550 Crystal Drive Suite 1300, Arlington, VA, USA
| | - Ripley Lucas
- Perinatal Data Center, March of Dimes, 1550 Crystal Drive Suite 1300, Arlington, VA, USA
| | - Ashley Stoneburner
- Perinatal Data Center, March of Dimes, 1550 Crystal Drive Suite 1300, Arlington, VA, USA
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Lee J, Howard KJ, Leong C, Grigsby TJ, Howard JT. Beyond Being Insured: Insurance Coverage Denial as a Major Barrier to Accessing Care During Pregnancy and Postpartum. Clin Nurs Res 2023; 32:1092-1103. [PMID: 37264856 PMCID: PMC10504817 DOI: 10.1177/10547738231177332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study investigates the association between insurance coverage denial and delays in care during pregnancy and postpartum. An online survey was administered in March and April 2022 to women who were either pregnant or within 1 year postpartum (n = 1,113). The outcome was delayed care, measured at four time points: during pregnancy and 1 week, 2 to 6 weeks, and after 7 weeks postpartum. The key covariate was insurance coverage denial by providers during pregnancy. Delayed care due to having an unaccepted insurance and being "out-of-network" was more pronounced at 1 week postpartum with 3.37 times and 3.47 times greater odds and in 2 to 6 weeks postpartum with 5.74 times and 2.97 times greater odds, respectively. The association between insurance denial and delays in care encapsulated transportation, rural residency, time issues, and financial constraints. The findings suggest that coverage denial is associated with significant delays in care, providing practical implications for effective perinatal care.
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Chen J, Ouyang L, Goodman DA, Okoroh EM, Romero L, Ko JY, Cox S. Association of Medicaid Expansion Under the Affordable Care Act With Medicaid Coverage in the Prepregnancy, Prenatal, and Postpartum Periods. Womens Health Issues 2023; 33:582-591. [PMID: 37951662 PMCID: PMC11018307 DOI: 10.1016/j.whi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION We evaluated how the Affordable Care Act (ACA) Medicaid eligibility expansion affected perinatal insurance coverage patterns for Medicaid-enrolled beneficiaries who gave birth overall and by race/ethnicity. We also examined state-level heterogeneous impacts. METHODS Using the 2011-2013 Medicaid Analytic eXtract and the 2016-2018 Transformed Medicaid Statistical Information System Analytic File databases, we identified 1.4 million beneficiaries giving birth in 2012 (pre-ACA expansion cohort) and 1.5 million in 2017 (post-ACA expansion cohort). We constructed monthly coverage rates for the two cohorts by state Medicaid expansion status and obtained difference-in-differences estimates of the association of Medicaid expansion with coverage overall and by race/ethnicity group (non-Hispanic White, non-Hispanic Black, and Hispanic). To explore state-level heterogeneous impacts, we divided the expansion and non-expansion states into groups based on the differences in the income eligibility limits for low-income parents in each state between 2012 and 2017. RESULTS Medicaid expansion was associated with 13 percentage points higher coverage in the 9 to 12 months before giving birth, and 11 percentage points higher coverage at 6 to 12 months postpartum. Hispanic birthing individuals had the greatest relative increases in coverage, followed by non-Hispanic White and non-Hispanic Black individuals. In Medicaid expansion states, those who experienced the greatest increases in income eligibility limits for low-income parents generally saw the greatest increases in coverage. In non-expansion states, there was less heterogeneity between state groupings. CONCLUSIONS Pregnancy-related Medicaid eligibility did not have major changes in the 2010s. However, states' adoption of ACA Medicaid expansion after 2012 was associated with increased Medicaid coverage before, during, and after pregnancy. The increases varied by race/ethnicity and across states.
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Affiliation(s)
- Jiajia Chen
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Mathematica, Atlanta, Georgia.
| | - Lijing Ouyang
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - David A Goodman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Ekwutosi M Okoroh
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Lisa Romero
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jean Y Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Pradhan S, Harvey SM, Bui LN, Yoon J. Postpartum Medicaid coverage and outpatient care utilization among low-income birthing individuals in Oregon: impact of Medicaid expansion. Front Public Health 2023; 11:1025399. [PMID: 37469686 PMCID: PMC10352675 DOI: 10.3389/fpubh.2023.1025399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 05/26/2023] [Indexed: 07/21/2023] Open
Abstract
Objective This study examined the effect of Medicaid expansion in Oregon on duration of Medicaid enrollment and outpatient care utilization for low-income individuals during the postpartum period. Methods We linked Oregon birth certificates, Medicaid enrollment files, and claims to identify postpartum individuals (N = 73,669) who gave birth between 2011 and 2015. We created one pre-Medicaid expansion (2011-2012) and two post-expansion (2014-2015) cohorts (i.e., previously covered and newly covered by Medicaid). We used ordinary least squares and negative binomial regression models to examine changes in postpartum coverage duration and number of outpatient visits within a year of delivery for the post-expansion cohorts compared to the pre-expansion cohort. We examined monthly and overall changes in outpatient utilization during 0-2 months, 3-6 months, and 7-12 months after delivery. Results Postpartum coverage duration increased by 3.14 months and 2.78 months for the post-Medicaid expansion previously enrolled and newly enrolled cohorts (p < 0.001), respectively. Overall outpatient care utilization increased by 0.06, 0.19, and 0.34 visits per person for the previously covered cohort and 0.12, 0.13, and 0.26 visits per person for newly covered cohort during 0-2 months, 3-6 months, and 7-12 months, respectively. Monthly change in utilization increased by 0.006 (0-2 months) and 0.004 (3-6 months) visits per person for post-Medicaid previously enrolled cohort and decreased by 0.003 (0-2 months) and 0.02 (7-12 months) visits per person among newly enrolled cohort. Conclusion Medicaid expansion increased insurance coverage duration and outpatient care utilization during postpartum period in Oregon, potentially contributing to reductions in pregnancy-related mortality and morbidities among birthing individuals.
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Affiliation(s)
- Satyasandipani Pradhan
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - S. Marie Harvey
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Linh N. Bui
- Public Health Program, School of Natural Sciences, Mathematics, and Engineering, California State University, Bakersfield, CA, United States
| | - Jangho Yoon
- Department of Preventive Medicine and Biostatistics, F. Edward Hebert School of Medicine, The Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Eliason E, Admon LK, Steenland MW, Daw JR. Late Postpartum Coverage Loss Before COVID-19: Implications For Medicaid Unwinding. Health Aff (Millwood) 2023; 42:966-972. [PMID: 37406233 PMCID: PMC10885010 DOI: 10.1377/hlthaff.2022.01659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Using unique Pregnancy Risk Assessment Monitoring System follow-up data from before the COVID-19 pandemic, we found that only 68 percent of prenatal Medicaid enrollees maintained continuous Medicaid coverage through nine or ten months postpartum. Of the prenatal Medicaid enrollees who lost coverage in the early postpartum period, two-thirds remained uninsured nine to ten months postpartum. State postpartum Medicaid extensions could prevent a return to prepandemic rates of postpartum coverage loss.
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Affiliation(s)
- Erica Eliason
- Erica Eliason , Brown University, Providence, Rhode Island
| | - Lindsay K Admon
- Lindsay K. Admon, University of Michigan, Ann Arbor, Michigan
| | | | - Jamie R Daw
- Jamie R. Daw, Columbia University, New York, New York
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Atherton KM, Poupore NS, Clemmens CS, Nietert PJ, Pecha PP. Sociodemographic Factors Affecting Loss to Follow-Up After Newborn Hearing Screening: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:1289-1300. [PMID: 36939626 PMCID: PMC10773460 DOI: 10.1002/ohn.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Universal newborn hearing screening (NBHS) has been widely implemented as a part of early hearing detection and intervention (EHDI) programs worldwide. Even with excellent provider knowledge and screening rates, many infants do not receive definitive hearing testing or intervention after initial screening. The objective of this study was to identify sociodemographic factors contributing to loss of follow-up. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS Per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the databases were searched from the date of inception through December 28, 2021. Studies containing sociodemographic information on patients who were referred to NBHS were included. Meta-analysis of odds ratios (ORs) was performed comparing rates of sociodemographic variables between patients adherent and nonadherent to follow-up. RESULTS A total of 169,238 infants from 19 studies were included. Low birth weight (OR 1.6 [95% confidence interval, CI 1.2-2.2, p < .001), racial minority (OR 1.4 [95% CI 1.2-1.6], p < .001), rural residence (OR 1.5 [95% CI 1.1-1.9], p = .005), lack of insurance (OR 1 [95% CI 1.4-2.5], p < .001), and public or state insurance (OR 1.7 [95% CI 1.2-4.2], p = .008) were associated with missed follow-up after referred NBHS. Associated maternal factors included low maternal education (OR 1.8 [95% CI 1.6-2.0], p < .001), young maternal age (OR 1.5 [95% CI 1.5-1.6], p < .001), unmarried maternal status (OR 1.5 [95% CI 1.1-1.9], p = .003), and current or former maternal smoking status (OR 1.8 [95% CI 1.4-2.2], p < .001). CONCLUSION Both infant and maternal sociodemographic factors influence follow-up compliance after referred NBHS. Focused efforts should be made by medical providers and policymakers to address these factors to ensure appropriate newborn hearing care and interventions are achieved.
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Affiliation(s)
- Kelly M. Atherton
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, South Carolina, Charleston, USA
| | - Nicolas S. Poupore
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Clarice S. Clemmens
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul J. Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Phayvanh P. Pecha
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Chen KK, Peahl AF, Danilack-Fekete VA, Stuebe AM, Balk EM. Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review. JAMA Netw Open 2023; 6:e2316536. [PMID: 37266938 PMCID: PMC10238947 DOI: 10.1001/jamanetworkopen.2023.16536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/02/2023] [Indexed: 06/03/2023] Open
Abstract
Importance Approximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care. Objective To assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum. Evidence Review Medline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide. Findings A total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits. Conclusions and Relevance The findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
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Affiliation(s)
- Ian J. Saldanha
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Gaelen P. Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Ghid Kanaan
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Michael L. Zahradnik
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Dale W. Steele
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Departments of Emergency Medicine and Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Kenneth K. Chen
- Department of Medicine, Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Alex F. Peahl
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
| | - Valery A. Danilack-Fekete
- Center for Outcomes Research and Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Alison M. Stuebe
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
| | - Ethan M. Balk
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
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Hettinger K, Margerison C. Postpartum Medicaid Eligibility Expansions and Postpartum Health Measures. Popul Health Manag 2023; 26:53-59. [PMID: 36637879 PMCID: PMC9969880 DOI: 10.1089/pop.2022.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Maternal mortality and morbidity in the United States are high compared with those in similar countries, and racial/ethnic disparities exist, with many of these events occurring in the later postpartum period. Proposed federal and recently enacted state policy interventions extend pregnancy Medicaid from covering 60 days to a full year postpartum. This study estimates the association between maintaining Medicaid eligibility in the later postpartum period (relative to only having pregnancy Medicaid eligibility) with postpartum checkup attendance and depressive symptoms using regression analysis, overall and stratified by race/ethnicity. People with postpartum Medicaid eligibility were 1.0%-1.4% more likely to attend a postpartum checkup relative to those with only pregnancy Medicaid eligibility overall, primarily driven by a 3.8%-4.0% higher likelihood among Hispanic postpartum people. Conversely, postpartum Medicaid is associated with a 2.2%-2.3% lower likelihood of postpartum checkup attendance for Black postpartum people. Postpartum eligibility is also associated with a 9.7%-11.6% lower likelihood of self-reported depressive symptoms compared with only pregnancy Medicaid eligibility for White postpartum people only. Postpartum Medicaid eligibility is associated with some improvements in maternal health care utilization and mental health, but differences by race and ethnicity imply that inequitable systems and structures that cannot be overcome by insurance alone may also play an important role in postpartum health.
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Affiliation(s)
- Katlyn Hettinger
- Department of Economics, Michigan State University, East Lansing, Michigan, USA
| | - Claire Margerison
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
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Eliason EL, Steenland MW. Association of New York State's Marketplace Special Enrollment Period for Pregnancy With Prenatal Insurance Coverage. JAMA HEALTH FORUM 2023; 4:e224907. [PMID: 36607698 PMCID: PMC9857356 DOI: 10.1001/jamahealthforum.2022.4907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This cross-sectional study uses Pregnancy Risk Assessment Monitoring System data to investigate the association between marketplace pregnancy special enrollment and prenatal insurance coverage in New York.
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Affiliation(s)
- Erica L. Eliason
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Maria W. Steenland
- Population Studies and Training Center, Brown University, Providence, Rhode Island
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Eliason EL, Daw JR. Presumptive eligibility for pregnancy Medicaid and timely prenatal care access. Health Serv Res 2022; 57:1288-1294. [PMID: 35808941 PMCID: PMC9643081 DOI: 10.1111/1475-6773.14035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess the association between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access. DATA SOURCE 2012-2019 National Center for Health Statistics natality files. STUDY DESIGN We used difference-in-differences to compare outcomes before (2012-2015) and after (2017-2019) presumptive eligibility in Kansas relative to seven control group states overall and stratified by maternal education. Outcomes included first-trimester prenatal care, the month of first prenatal visit, and adequate prenatal care. DATA COLLECTION/EXTRACTION METHODS All live births among adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming. PRINCIPAL FINDINGS Among all births, we found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with a 1.92 percentage-point increase (95% CI: 0.64, 4.35) in first-trimester prenatal care, driven by earlier month of first prenatal care visit. CONCLUSIONS Presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care among individuals with lower education, but other interventions may be needed.
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Affiliation(s)
- Erica L. Eliason
- Department of Health Services, Policy, & PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Jamie R. Daw
- Department of Health Policy & ManagementColumbia University Mailman School of Public HealthNew YorkNew YorkUSA
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12
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Wording Error in Title. JAMA Netw Open 2022; 5:e2146242. [PMID: 34989799 PMCID: PMC8739766 DOI: 10.1001/jamanetworkopen.2021.46242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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