负担得起的护理法案与产前护理使用和分娩结果的关联
Jamie R Daw1, Benjamin D Sommers2,3
1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
JAMA
|February 17, 2018
概括
"负担得起的医疗保健法"允许年轻人继续获得父母保险,改善了分娩支付来源和产前护理的使用,并略有减少了24至25岁的早产. 这些积极影响在未婚女性中最为明显.
科学领域:
- 医疗服务研究
- 公共卫生政策
- 生殖健康
背景情况:
- "负担得起的医疗保健法" (ACA) 引入了一项依赖性保险条款,允许年轻人在26岁之前继续享受父母的医疗保险.
- 这一规定对与怀孕相关的医疗保健利用和分娩结果的影响在很大程度上仍未得到研究.
研究的目的:
- 调查 ACA 的依赖性保险条款与分娩保险支付的变化之间的联系.
- 评估该条款对产前护理和分娩结果的影响.
主要方法:
- 一个回顾性队列研究使用了个人级别的出生证明数据.
- 一个差异分析比较了24-25岁的妇女 (暴露) 和27-28岁的妇女 (控制) 在 (2009) 和 (2011-2013) 条款颁布之前.
- 结果包括分娩支付来源,产前护理时间和充分性以及婴儿健康指标;分析按婚姻状况分层.
主要成果:
- 年轻妇女的私人保险支付增加和医疗补助/自费支付减少.
- 与对照组相比,暴露组的早期和适当的产前护理使用率显著增加.
- 观察到过早分娩的数量有所减少,而低出生体重,新生儿集中治疗室入院率和剖腹产率没有显著变化.
- 分层分析表明,薪酬,产前护理和早产率的改善主要集中在未婚女性中.
结论:
- ACA依赖性保险条款与改善分娩保险和改善年轻成年人产前护理的机会有关.
- 这项规定对减少早产,特别是未婚妇女的数量产生了积极的影响.
- 没有发现对剖腹产,低出生体重或新生儿重症监护室住院率的显著影响.
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