在医疗补助中获得围产期陪护服务:对两个州的案例分析。

Health affairs scholar Pub Date : 2024-03-04 eCollection Date: 2024-03-01 DOI:10.1093/haschl/qxae023
Cara B Safon, Lois McCloskey, Maria Guadalupe Estela, Sarah H Gordon, Megan B Cole, Jack Clark
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引用次数: 0

摘要

朵拉服务支持母婴健康,但很少有医疗补助项目对其进行报销。通过对主要政策信息提供者(n = 20)进行定性访谈,本研究通过对两个州的朵拉相关政策的看法,探讨了医疗补助报销的促进因素和障碍:俄勒冈州的朵拉护理已获报销,马萨诸塞州的朵拉护理尚待报销。将朵拉服务纳入医疗补助有五个主题。在主题1中,利益相关者认识到扩大朵拉服务的可及性势在必行。随后的主题代表了实现这一目标的复杂性。在主题2中,朵拉服务不被医疗服务提供者重视的观点导致了朵拉与医疗系统之间的冲突。在主题3中,复杂的计费过程造成了摩擦并阻碍了报销。在主题4中,内部冲突阻碍了政策的制定。在主题 5 中,马萨诸塞州的州政府和朵拉社区之间的结构性分裂非常突出,在政策制定过程中造成了紧张关系。信息提供者报告了一些需要解决的问题,以建立公平和健全的朵拉关怀政策。朵拉服务的医疗补助(Medicaid)覆盖范围需要与朵拉、提供者和医疗保健倡导者持续合作。
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Access to perinatal doula services in Medicaid: a case analysis of 2 states.

Doula services support maternal and child health, but few Medicaid programs reimburse for them. Through qualitative interviews with key policy informants (n = 20), this study explored facilitators and barriers to Medicaid reimbursement through perceptions of doula-related policies in 2 states: Oregon, where doula care is reimbursed, and Massachusetts, where reimbursement is pending. Five themes characterize the inclusion of doula services in Medicaid. In Theme 1, stakeholders recognized an imperative to expand access to doula services. Subsequent themes represent complications in accomplishing that imperative. In Theme 2, perceptions that doula services were not valued by health care providers resulted in conflict between doulas and the health care system. In Theme 3, complex billing processes created friction and impeded reimbursement. In Theme 4, internal conflict presented barriers to policymaking. In Theme 5, structural fragmentation between state government and doula communities was prominent in Massachusetts, presenting tensions during policymaking. Informants reported on problems demanding resolution to establish equitable and robust doula care policies. Medicaid coverage of doula services requires ongoing collaboration with doulas, providers, and health care advocates.

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