Health Insurance Type and Access to the Indian Health Service Before, During, and After Childbirth Among American Indian and Alaska Native People in the United States
IF 2.8 2区 医学Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Jessica L. Liddell PhD, MSW/MPH , Julia D. Interrante PhD, MPH , Emily C. Sheffield MPH , Hailey A. Baker BS , Katy B. Kozhimannil PhD, MPA
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引用次数: 0
Abstract
Background
American Indian and Alaska Native (AI/AN) people in the United States face elevated childbirth-related risks when compared with non-Hispanic white people. Access to health care is a treaty right of many AI/AN people, often facilitated through the Indian Health Service (IHS), but many AI/AN people do not qualify for or cannot access IHS care and rely on health insurance coverage to access care in other facilities. Our goal was to describe health insurance coverage and access to IHS care before, during, and after childbirth for AI/AN birthing people in the United States.
Methods
We analyzed 2016 to 2020 Pregnancy Risk Assessment Monitoring System data (44 states and two other jurisdictions) for 102,860 postpartum individuals (12,920 AI/AN and 89,940 non-Hispanic white). We calculated weighted percentages, adjusted predicted probabilities, and percentage point differences for health care coverage (insurance type and IHS care) before, during, and after childbirth.
Results
Approximately 75% of AI/AN birthing people did not have IHS care around the time of childbirth. AI/AN people had greater variability in insurance coverage and more insurance churn (changes in type of insurance, including between coverage and no coverage) during the perinatal period, compared with non-Hispanic white people. Health care coverage differed for rural and urban AI/AN people, with rural AI/AN residents having the lowest prevalence of continuous insurance (60%).
Conclusion
AI/AN birthing people experience insurance churning and limited access to IHS care during the perinatal period. Efforts to improve care for AI/AN birthing people should engage federal, state, and tribal entities to ensure fulfillment of the trust responsibility of the United States and to address health inequities.
美国印第安人和阿拉斯加原住民在分娩前、分娩期间和分娩后的医疗保险类型和获得印第安人医疗服务的情况》(Health Insurance Type and Access to the Indian Health Service Before, During, and After Childbirth Among American Indian and Alaska Native People in the United States)。
期刊介绍:
Women"s Health Issues (WHI) is a peer-reviewed, bimonthly, multidisciplinary journal that publishes research and review manuscripts related to women"s health care and policy. As the official journal of the Jacobs Institute of Women"s Health, it is dedicated to improving the health and health care of all women throughout the lifespan and in diverse communities. The journal seeks to inform health services researchers, health care and public health professionals, social scientists, policymakers, and others concerned with women"s health.