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Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study.
J Womens Health (Larchmt). 2020 01; 29(1):29-37.JW

Abstract

Background:

Lack of quality preventive care has been associated with poorer outcomes for pregnant women with low incomes. Health policy changes implemented with the Affordable Care Act (ACA) were designed to improve access to care. However, insurance coverage remains lower among women in Medicaid nonexpansion states. We compared health care use and adverse birth outcomes by insurance status among women giving birth in a large health system in a Medicaid nonexpansion state. Materials and

Methods:

We conducted a population-based retrospective cohort study using data for 9,613 women with deliveries during 2014-2015 at six hospitals associated with a large vertically integrated health care system in North Carolina. Adjusted logistic regression and zero-inflated negative binomial models examined associations between insurance status at delivery (commercial, Medicaid, or uninsured) and health care utilization (well-woman visits, late prenatal care, adequacy of prenatal care, postpartum follow-up, and emergency department [ED] visits) and outcomes (preterm birth, low birth weight, preeclampsia, and gestational diabetes).

Results:

Having Medicaid at delivery was associated with lower rates of well-woman visits (rate ratio [RR] 0.25, 95% CI 0.23-0.28), higher rates of ED visits (RR 2.93, 95% CI 2.64-3.25), and higher odds of late prenatal care (odds ratio [OR] 1.18, 95% CI 1.03-1.34) compared to having commercial insurance, with similar results for uninsured women. Differences in adverse pregnancy outcomes were not statistically significant after adjusting for patient characteristics.

Conclusions:

Findings suggest that large gaps exist in use of preventive care between Medicaid/uninsured and commercially insured women. Policymakers should consider ways to improve potential and realized access to care.

Authors+Show Affiliations

Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina.Department of Population Health Science and Policy, Department of Obstetrics, Gynecology, and Reproductive Science, and the Blavatnik Family Women's Health Research Institute at the Icahn School of Medicine at Mount Sinai, New York, New York.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31397625

Citation

Taylor, Yhenneko J., et al. "Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: a Retrospective Cohort Study." Journal of Women's Health (2002), vol. 29, no. 1, 2020, pp. 29-37.
Taylor YJ, Liu TL, Howell EA. Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study. J Womens Health (Larchmt). 2020;29(1):29-37.
Taylor, Y. J., Liu, T. L., & Howell, E. A. (2020). Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study. Journal of Women's Health (2002), 29(1), 29-37. https://doi.org/10.1089/jwh.2019.7658
Taylor YJ, Liu TL, Howell EA. Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: a Retrospective Cohort Study. J Womens Health (Larchmt). 2020;29(1):29-37. PubMed PMID: 31397625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insurance Differences in Preventive Care Use and Adverse Birth Outcomes Among Pregnant Women in a Medicaid Nonexpansion State: A Retrospective Cohort Study. AU - Taylor,Yhenneko J, AU - Liu,Tsai-Ling, AU - Howell,Elizabeth A, Y1 - 2019/08/09/ PY - 2019/8/10/pubmed PY - 2020/7/8/medline PY - 2019/8/10/entrez KW - affordable care act KW - emergency visits KW - health disparities KW - pregnancy outcomes KW - prenatal care SP - 29 EP - 37 JF - Journal of women's health (2002) JO - J Womens Health (Larchmt) VL - 29 IS - 1 N2 - Background: Lack of quality preventive care has been associated with poorer outcomes for pregnant women with low incomes. Health policy changes implemented with the Affordable Care Act (ACA) were designed to improve access to care. However, insurance coverage remains lower among women in Medicaid nonexpansion states. We compared health care use and adverse birth outcomes by insurance status among women giving birth in a large health system in a Medicaid nonexpansion state. Materials and Methods: We conducted a population-based retrospective cohort study using data for 9,613 women with deliveries during 2014-2015 at six hospitals associated with a large vertically integrated health care system in North Carolina. Adjusted logistic regression and zero-inflated negative binomial models examined associations between insurance status at delivery (commercial, Medicaid, or uninsured) and health care utilization (well-woman visits, late prenatal care, adequacy of prenatal care, postpartum follow-up, and emergency department [ED] visits) and outcomes (preterm birth, low birth weight, preeclampsia, and gestational diabetes). Results: Having Medicaid at delivery was associated with lower rates of well-woman visits (rate ratio [RR] 0.25, 95% CI 0.23-0.28), higher rates of ED visits (RR 2.93, 95% CI 2.64-3.25), and higher odds of late prenatal care (odds ratio [OR] 1.18, 95% CI 1.03-1.34) compared to having commercial insurance, with similar results for uninsured women. Differences in adverse pregnancy outcomes were not statistically significant after adjusting for patient characteristics. Conclusions: Findings suggest that large gaps exist in use of preventive care between Medicaid/uninsured and commercially insured women. Policymakers should consider ways to improve potential and realized access to care. SN - 1931-843X UR - https://www.unboundmedicine.com/medline/citation/31397625/Insurance_Differences_in_Preventive_Care_Use_and_Adverse_Birth_Outcomes_Among_Pregnant_Women_in_a_Medicaid_Nonexpansion_State:_A_Retrospective_Cohort_Study_ L2 - https://www.liebertpub.com/doi/10.1089/jwh.2019.7658?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -