在堕胎研究中使用医疗补助管理数据的局限性。

IF 2.8 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Contraception Pub Date : 2025-02-01 DOI:10.1016/j.contraception.2024.110704

Brittni Frederiksen , Emily Dennis , Guodong Liu , Doug Leslie , Alina Salganicoff , Sarah Roberts

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引用次数: 0

摘要

研究目的：通过比较医疗补助计划报销数据中的人工流产计数和各州人工流产估计数，找出全国医疗补助计划报销档案中人工流产数据的局限性：研究设计：我们使用程序（CPT、HCPCS）和药物（NDC）代码来识别 2009 年和 2010 年医疗补助分析摘要（MAX）和 2020 年转换医疗补助统计信息系统分析文件（TAF）数据中的人工流产索赔。我们将 MAX 和 TAF 中的人工流产数量与整个医疗补助计划和各州的预期人工流产数量进行了比较。根据最近发表的研究，我们估计，在使用州基金为医疗补助计划参保者提供堕胎服务的州，医疗补助计划涵盖的预期堕胎数量占堕胎总数的 62%，而在遵循海德限制的州，预期堕胎数量占堕胎总数的 0.9%：MAX 数据确定了 2009 年预期由 Medicaid 承担的堕胎率为 11%（38,668/345,480 例），2010 年预期由 Medicaid 承担的堕胎率为 13%（44,528/330,801 例）。在 2020 年的 TAF 数据中，我们发现了 25% （69,728/279,048）的预期医疗补助涵盖的人工流产。在 2020 年使用州资金为医疗补助计划参保者支付堕胎费用的 16 个州中，大多数州都有结论：MAX/TAF 中的人工流产索赔少计了医疗补助计划承保的人工流产，而这种少计在各州之间存在差异。跨州和跨时间的报告差异可能会给任何试图跨州和跨时间使用 MAX/TAF 人工流产申请的研究带来偏差。研究人员在使用 MAX/TAF 进行堕胎相关研究时应格外谨慎：研究人员在使用医疗补助分析摘要（MAX）和转换后的医疗补助统计信息系统分析文件（TAF）进行堕胎相关研究时应谨慎。

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The limitations of using Medicaid administrative data in abortion research

Objectives

To identify limitations of abortion data in national Medicaid claims files by comparing abortion counts in Medicaid claims data with state abortion estimates.

Study design

We used procedure (Current Procedural Terminology/Healthcare Common Procedure Coding System) and drug (National Drug Code) codes to identify abortion claims in 2009 and 2010 Medicaid Analytic eXtract (MAX) and 2020 Transformed Medicaid Statistical Information System Analytic File (TAF) data. We compared the number of abortions in MAX and TAF to the number of expected abortions covered by Medicaid overall and by state. Based on recent published research, we estimated expected Medicaid-covered abortions as 62% of total abortions in states using state funds to cover abortion services for Medicaid enrollees and 0.9% in states that follow Hyde restrictions.

Results

MAX data identified 11% (38,668/345,480) of expected Medicaid-covered abortions in 2009 and 13% (44,528/330,801) of expected Medicaid-covered abortions in 2010. In 2020 TAF data, we found 25% (69,728/279,048) of the expected Medicaid-covered abortions. Among the 16 states that used state funds to cover abortions for Medicaid enrollees in 2020, the majority had <10% of expected Medicaid-covered abortions (n = 8). Three states had between 10% and 50% of expected abortions. Four states had between 51% and 75% of expected abortions. One state had insufficient data for reporting.

Conclusions

Abortion claims in MAX/TAF are an undercount of abortions covered by Medicaid, and this undercount varies across states. Variation in reporting across states and across time likely introduces bias into research trying to use MAX/TAF abortion claims across states and time. Researchers should use extreme caution when using MAX/TAF for abortion-related research.

Implications

Researchers should use caution when using the Medicaid Analytic eXtract and Transformed Medicaid Statistical Information System Analytic Files for abortion-related research questions.

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来源期刊

Contraception 医学-妇产科学

CiteScore

4.70

自引率

17.20%

发文量

211

审稿时长

69 days

期刊介绍： Contraception has an open access mirror journal Contraception: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal Contraception wishes to advance reproductive health through the rapid publication of the best and most interesting new scholarship regarding contraception and related fields such as abortion. The journal welcomes manuscripts from investigators working in the laboratory, clinical and social sciences, as well as public health and health professions education.