Postpartum Insurance Loss: Predicting Factors, Associations with Postpartum Health Service Utilization, and the Role of Medicaid Expansion.

Autor: Manalew WS; Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, 42 Lamb Hall, PO Box 70264, Johnson City, TN, USA. manalew@etsu.edu.; East Tennessee State University, Johnson City, TN, 37614, USA. manalew@etsu.edu., White M; Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, 42 Lamb Hall, PO Box 70264, Johnson City, TN, USA.; East Tennessee State University, Johnson City, TN, 37614, USA., Lee J; College for Health, Community and Policy, University of Texas, San Antonio, San Antonio, TX, 78249, USA., Hale N; Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, 42 Lamb Hall, PO Box 70264, Johnson City, TN, USA.; East Tennessee State University, Johnson City, TN, 37614, USA.
Jazyk: angličtina
Zdroj: Maternal and child health journal [Matern Child Health J] 2024 Oct; Vol. 28 (10), pp. 1782-1792. Date of Electronic Publication: 2024 Aug 07.
DOI: 10.1007/s10995-024-03979-3
Abstrakt: Objectives: This study investigated the predictors of postpartum insurance loss (PPIL), assessed its association with postpartum healthcare receipt, and explored the potential buffering role of Medicaid expansion.
Methods: Data from the 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed, covering 197,820 individuals with live births. PPIL was determined via self-reported insurance status before and after pregnancy. Postpartum visits and depression screening served as key health service receipt indicators. The association between PPIL and maternal characteristics was examined using bivariate analysis. The association of PPIL with health service receipt was assessed through odds ratios derived from multivariate logistic regression models. The role of Medicaid expansion was explored by interacting ACA Medicaid expansion status with the dichotomous PPIL indicator.
Results: PPIL was experienced by 7.8% of postpartum people, with higher rates in Medicaid non-expansion states (13.6%) compared to 6.1% in expansion states (p < 0.05). Racial and ethnic disparities were observed, with 16.5% of Hispanic and 4.6% of white people experiencing PPIL. Individuals who experienced PPIL had decreased odds of attending postpartum visits (adjusted odds ratio (aOR) = 0.81, 95% CI = 0.73-0.90) and receiving screening for postpartum depression (aOR = 0.86, 95% CI = 0.78-0.96) compared to those who maintained insurance coverage. People in expansion states with no PPIL had higher odds of postpartum depression screening (aOR = 1.33, 95% CI = 1.08-1.62). No differences in postpartum visits in expansion versus non-expansion were noted (aOR = 1.13, 95% CI = 0.93-1.36).
Conclusions for Practice: Ensuring consistent postpartum insurance coverage offers policymakers a chance to enhance healthcare access and outcomes, particularly for vulnerable groups.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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