Abstract：
OBJECTIVE: 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: Ensuring consistent postpartum insurance coverage offers policymakers a chance to enhance healthcare access and outcomes, particularly for vulnerable groups.
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: Ensuring consistent postpartum insurance coverage offers policymakers a chance to enhance healthcare access and outcomes, particularly for vulnerable groups.
摘要：
目的：本研究调查了产后保险损失(PPIL)的预测因素，评估其与产后医疗保健收据的关联，并探讨了医疗补助扩大的潜在缓冲作用。
方法：分析了2016-2020年妊娠风险评估监测系统（PRAMS）的数据，涵盖197,820名活产者。PPIL是通过怀孕前后的自我报告保险状态确定的。产后访视和抑郁症筛查是关键的卫生服务接收指标。使用双变量分析检查PPIL与母体特征之间的关联。通过多元逻辑回归模型得出的比值比评估了PPIL与卫生服务接收的关联。通过将ACAMedicaid扩展状态与二分PPIL指标相互作用来探索Medicaid扩展的作用。
结果：产后有7.8%的人经历了PPIL，医疗补助非扩张州的比率较高（13.6%），而扩张州的比率为6.1%（p<0.05）。观察到种族和族裔差异，16.5%的西班牙裔和4.6%的白人经历PPIL。与那些保持保险范围的人相比，经历过PPIL的人产后就诊的几率降低（调整后的优势比（aOR）=0.81，95％CI=0.73-0.90）和接受产后抑郁症筛查（aOR=0.86，95％CI=0.78-0.96）。没有PPIL的扩张状态的人产后抑郁症筛查的几率更高（aOR=1.33，95％CI=1.08-1.62）。产后访视的扩张与非扩张没有差异（aOR=1.13，95％CI=0.93-1.36）。
结论：确保一致的产后保险覆盖为政策制定者提供了一个机会，以提高医疗保健的可得性和结果，特别是弱势群体。
方法：分析了2016-2020年妊娠风险评估监测系统（PRAMS）的数据，涵盖197,820名活产者。PPIL是通过怀孕前后的自我报告保险状态确定的。产后访视和抑郁症筛查是关键的卫生服务接收指标。使用双变量分析检查PPIL与母体特征之间的关联。通过多元逻辑回归模型得出的比值比评估了PPIL与卫生服务接收的关联。通过将ACAMedicaid扩展状态与二分PPIL指标相互作用来探索Medicaid扩展的作用。
结果：产后有7.8%的人经历了PPIL，医疗补助非扩张州的比率较高（13.6%），而扩张州的比率为6.1%（p<0.05）。观察到种族和族裔差异，16.5%的西班牙裔和4.6%的白人经历PPIL。与那些保持保险范围的人相比，经历过PPIL的人产后就诊的几率降低（调整后的优势比（aOR）=0.81，95％CI=0.73-0.90）和接受产后抑郁症筛查（aOR=0.86，95％CI=0.78-0.96）。没有PPIL的扩张状态的人产后抑郁症筛查的几率更高（aOR=1.33，95％CI=1.08-1.62）。产后访视的扩张与非扩张没有差异（aOR=1.13，95％CI=0.93-1.36）。
结论：确保一致的产后保险覆盖为政策制定者提供了一个机会，以提高医疗保健的可得性和结果，特别是弱势群体。
