Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women.

IF 8.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES Health Affairs Pub Date : 2024-03-01 DOI:10.1377/hlthaff.2023.00672
Kate W Strully, Pinka Chatterji, Han Liu, Soojin Han, Lawrence Schell
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Abstract

American Indian/Alaska Native (AI/AN) women experience distinct political and health care environments and possess unique health risks and resources. We tested whether state Medicaid expansions under the Affordable Care Act were associated with health insurance, prenatal care, health conditions, and birth outcomes among AI/AN women. Using data from the 2010-19 American Community Survey and 2010-19 US birth certificates, we used a difference-in-differences study design to compare outcomes among AI/AN women before and after Medicaid expansions. Medicaid expansions increased the proportion of AI/AN women reporting health care coverage from both Medicaid and the Indian Health Service (IHS), with larger effects among women living in areas with relatively high percentages of reservation land. Consistent with prior research on the broader population of women, Medicaid expansions had no effects on first-trimester prenatal care usage or birthweight among AI/AN women. We found mixed evidence of increased rates of prepregnancy chronic conditions after the expansions. Our findings demonstrate the importance of Medicaid, the IHS, and tribal health systems as sources of health care coverage for AI/AN women of childbearing age.

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医疗补助扩展对美国印第安人/阿拉斯加原住民妇女的保险、产前护理和健康的影响。
美国印第安人/阿拉斯加原住民(AI/AN)妇女经历着不同的政治和医疗环境,拥有独特的健康风险和资源。我们测试了根据《平价医疗法案》扩大州医疗补助是否与美国印第安人/阿拉斯加原住民妇女的医疗保险、产前护理、健康状况和分娩结果有关。利用 2010-19 年美国社区调查和 2010-19 年美国出生证明的数据,我们采用了差异研究设计,比较了医疗补助计划扩大前后阿拉斯加原住民/印第安人妇女的生育结果。医疗补助计划的扩大提高了报告医疗补助计划和印第安人健康服务(IHS)医疗保险的美国原住民/印第安人妇女的比例,对居住在保留地比例相对较高地区的妇女的影响更大。与之前对更广泛妇女群体的研究结果一致,医疗补助计划的扩大对阿拉斯加原住民/印第安人妇女第一胎产前护理的使用率或出生体重没有影响。我们发现,在扩大医疗补助范围后,孕前慢性病的发病率有所上升,但证据不一。我们的研究结果表明,医疗补助计划(Medicaid)、国际医疗服务系统(IHS)和部落医疗系统作为育龄美国印第安人/原住民妇女的医疗保险来源非常重要。
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来源期刊
Health Affairs
Health Affairs 医学-卫生保健
CiteScore
15.00
自引率
2.10%
发文量
246
审稿时长
3-6 weeks
期刊介绍: Health Affairs is a prestigious journal that aims to thoroughly examine significant health policy matters both domestically and globally. Our publication is committed to addressing issues that are relevant to both the private and public sectors. We are enthusiastic about inviting private and public decision-makers to contribute their innovative ideas in a publishable format. Health Affairs seeks to incorporate various perspectives from industry, labor, government, and academia, ensuring that our readers benefit from the diverse viewpoints within the healthcare field.
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