期刊
AMERICAN JOURNAL OF PREVENTIVE MEDICINE
卷 58, 期 1, 页码 1-11出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.amepre.2019.08.019
关键词
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资金
- Michigan Applied Public Policy Research from the Michigan State University Institute for Public Policy and Social Research
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01HD095951]
Introduction: Preconception and interconception health care are critical means of identifying, managing, and treating risk factors originating before pregnancy that can harm fetal development and maternal health. However, many women in the U.S. lack health insurance, limiting their ability to access such care. State-level variation in Medicaid eligibility, particularly before and after the 2014 Medicaid expansions, offers a unique opportunity to test the hypothesis that increasing healthcare coverage for low-income women can improve preconception and interconception healthcare access and utilization, chronic disease management, overall health, and health behaviors. Methods: In 2018-2019, data on 58,365 low-income women aged 18-44 years from the 2011-2016 Behavioral Risk Factor Surveillance System were analyzed, and a difference-in-difference analysis was used to examine the impact of Medicaid expansions on preconception health. Results: Expanded Medicaid eligibility was associated with increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care because of cost, heavy drinking, and binge drinking. Medicaid eligibility did not impact diagnoses of chronic conditions, smoking cessation, or BMI. Medicaid eligibility was associated with greater gains in health insurance, utilization, and health among married (vs unmarried) women. Conversely, women with any (vs no) dependent children experienced smaller gains in insurance following the Medicaid expansion, but greater take-up of insurance when eligibility increased and larger behavioral responses to gaining insurance. Conclusions: Expanded Medicaid coverage may improve access to and utilization of health care among women of reproductive age, which could ultimately improve preconception health. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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