在保险集团内的严重孕产妇死亡率的种族差异分解
E Kathleen Adams1, Sara Markowitz2, Michael R Kramer3
1Department of Health Policy and Management (HPM), Rollins School of Public Health (RSPH), Emory University, Atlanta, Georgia, USA.
Health economics
|June 21, 2025
概括
严重孕产妇发病率 (SMM) 的种族差异受医院护理和住院因素的影响. 医院内部的流程显著解释了黑白SMM差距,特别是对于医疗补助患者.
科学领域:
- 孕产妇健康 孕产妇健康
- 健康差异 在健康上的差异
- 医疗保健服务研究 医疗服务研究
背景情况:
- 严重孕产妇发病率与孕产妇,医院和住院因素有关.
- 这些因素对不同保险集团中中小企业的种族差异的贡献仍然不清楚.
- 了解这些差异对于改善孕产妇健康结果至关重要.
研究的目的:
- 调查孕产妇,医院和住院因素对SMM种族差异的贡献.
- 为了比较医疗补助和私人保险团体之间的黑白SMM差距.
- 用Oaxaca-Blinder分解量化SMM差距的解释部分.
主要方法:
- 利用链接的格鲁吉亚重要记录和2016-2020年医院出院数据.
- 在分娩期间和产后42天内识别的SMM.
- 使用Oaxaca-Blinder分解与线性概率模型,包括医院固定效应.
主要成果:
- 黑白SMM差距在医疗补助 (1.15/100) 较私人保险 (1.40/100) 个人较低.
- 与私人保险 (29.4%) 相比,医院固定效应解释了医疗补助 (42.9%) 的差距的较大部分.
- 住宅因素减少了医疗补助 (-19.6%) 的解释差距,但对私人保险人 (0%) 的影响很小.
结论:
- 根据种族在医院内部流程的差异大大导致了黑人-白人的SMM差距.
- 住所因素,特别是提供者接入,可能有助于缩小医疗补助保险人群之间的差距.
- 需要针对医院护理和社会经济因素的有针对性的干预措施来减少中小企业的差异.
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