产后保险中断与处方避孕方法的使用[ID: 1377734]

Kimberly Schaefer, Michele Hacker, Summer Hawkins, Rose Molina
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摘要

简介:医疗补助资格收入门槛在怀孕期间增加,并在产后60天结束。因此,这个产后时期特别容易受到保险中断的影响,这可能会减少避孕的机会。方法:使用妊娠风险评估监测系统(2012-2020年)在42个州的调查数据。分娩后2个月或更长时间评估暴露情况,分为连续保险、保险损失、不连续的医疗补助转私人和不连续的私人医疗补助。我们使用修正泊松回归来估计使用需要处方的避孕方法与非处方方法/不使用避孕方法的风险比(rr), 95% ci,并根据种族和民族、语言、教育、年龄、婚姻状况、联邦贫困水平和年份进行调整。然后我们根据分娩时的医疗补助扩张状况进行分层。结果:在246,088名受访者中,76.4%的人从分娩到产后2个月或更长时间连续参加保险,11.9%的人失去保险,7.6%的人经历了从医疗补助到私人保险的不连续性,4.1%的人经历了从私人到医疗补助的不连续性。与连续保险相比,处方产后避孕的保险损失调整后的RR为0.88 (CI 0.86-0.89),医疗补助到私人的非连续性调整后的RR为0.99 (CI 0.97-1.01),私人到医疗补助的非连续性调整后的RR为0.96 (CI 0.93-0.98)。按医疗补助扩张状况分层也产生了类似的结果。在没有医疗补助扩张的州或时间段的受访者中,16.2%的人经历过保险损失,而在医疗补助扩张的州或时间段,这一比例为7.9%。结论:分娩后2个月或更长时间的保险损失与产后处方避孕的可能性降低有关,没有扩大医疗补助的受访者中有较高比例易受此类保险损失的影响。更多的州采用联邦产后12个月医疗补助延长选项可以改善获得产后处方避孕。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postpartum Insurance Discontinuity and Use of Prescription Contraceptive Methods [ID: 1377734]
INTRODUCTION: Medicaid eligibility income thresholds increase during pregnancy and historically ended 60 days postpartum. Thus, this postpartum period is especially vulnerable to insurance discontinuity, which may decrease access to contraception. METHODS: We used Pregnancy Risk Assessment Monitoring System survey data (2012–2020) in 42 states. Exposure, assessed 2 or more months after childbirth, was categorized as continuous insurance, insurance loss, discontinuous Medicaid-to-private, and discontinuous private-to-Medicaid. We used modified Poisson regression to estimate risk ratios (RRs) with 95% CIs for using contraception methods requiring prescriptions compared to nonprescription methods/none, adjusted for race and ethnicity, language, education, age, marital status, federal poverty level, and year. We then stratified by Medicaid expansion status at time of delivery. RESULTS: Of 246,088 respondents, 76.4% held continuous insurance from childbirth to 2 or more months postpartum, 11.9% lost insurance, 7.6% experienced discontinuity from Medicaid-to-private insurance, and 4.1% from private-to-Medicaid. Compared to continuous insurance, the adjusted RR for prescription postpartum contraception was 0.88 (CI 0.86–0.89) for loss of insurance, 0.99 (0.97–1.01) for discontinuous Medicaid-to-private, and 0.96 (0.93–0.98) for discontinuous private-to-Medicaid. Stratification by Medicaid expansion status yielded similar results. Of respondents in states or time periods without Medicaid expansion, 16.2% experienced insurance loss compared to 7.9% of those with Medicaid expansion. CONCLUSION: Insurance loss 2 or more months after childbirth was associated with decreased likelihood of prescription postpartum contraception, with a higher proportion of respondents without Medicaid expansion vulnerable to such insurance loss. Increased state adoption of the federal 12-month postpartum Medicaid extension option could improve access to prescription postpartum contraception.
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