The Effects of Medicaid Reimbursement of Immediate Postpartum Long-Acting Reversible Contraception on Reproductive Health Outcomes

产后立即长效可逆避孕药的医疗补助报销对生殖健康结果的影响

• 批准号: 10557298
• 负责人: Taryn AG Quinlan
• 金额: $ 3.01万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2023-04-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10557298
• 关键词: Effects; Medicaid; Reimbursement; Immediate; Postpartum

More than half of repeat pregnancies with short interpregnancy intervals (≤18 months between live birth and conception of a subsequent pregnancy) are unintended.1 Unintended and short interval pregnancy has significant adverse health and socioeconomic outcomes for women and their families. The immediate health impacts include increased risk of preterm birth, low birth weight, preeclampsia, maternal depression and intimate partner violence, and lower rates of breastfeeding.2-5,20 In the longer-term, unintended childbearing is associated with higher rates of poverty and less family stability.8 Young, poor, black and Hispanic women, and women of lower income or education are more likely to experience unintended short interval pregnancy.6,7 Due to these consequences, a 2030 Healthy People objective is to reduce short interval pregnancies by 20%.9 Receipt of highly effective birth control like long-acting reversible contraception (LARC) in the immediate postpartum period (IPP; time between delivery and hospital discharge) can reduce unintended and short interval pregnancy. Yet, 40-75% of women who plan to use a LARC method postpartum do not receive it.10 A primary barrier to widespread adoption of IPP LARC has been the inability to obtain reimbursement for LARC devices and insertion provided immediately postpartum. To address this barrier, some state Medicaid programs have started to reimburse for IPP LARC insertion, for the device, or both outside of the reimbursement of labor and delivery costs. Absent this policy, states pay for labor and delivery services using a “bundled” payment that does not allow for reimbursement of individual procedures, drugs, or devices. Existing evidence for Medicaid IPP LARC reimbursement is limited to analyses within single hospitals or single states looking at short-term effects of policy adoption (e.g., hospital implementation and LARC uptake) or rely on methods that assume that all factors affecting pregnancy outcomes can be accounted for with covariates. This study seeks to fill gaps in the evidence by examining long-term, population-level effects utilizing a quasi- experimental research design. First, I will estimate the effect of Medicaid IPP LARC reimbursement policy on the probability of using a LARC method postpartum and probability of an unintended pregnancy. Next, I will estimate the effect of the reimbursement policy on the risk of short interval pregnancy. Lastly, I will estimate the extent to which hospital type impacts the risk of short interval pregnancy. Three types of hospitals, teaching hospitals, hospitals with a high proportion of Medicaid patients, and 340B entities, may be more responsive to the policy change because these hospitals serve populations of women at increased risk for short interval pregnancy and have supportive structures to successfully implement a IPP LARC program.12,13 This proposal is aligned with multiple AHRQ research priorities, including racial/ethnic minorities, low-income, women, and access to care.

超过一半的重复怀孕，并在短时间内（在生日和生物之间≤18个月） 随后怀孕的概念是意想不到的。1意想不到的间隔和短时间怀孕 妇女及其家人的严重不利健康和社会经济成果。直接健康 影响包括早产，低出生体重，先兆子痫，材料抑郁和增加的风险增加 亲密的伴侣暴力和较低的母乳喂养。2-5,20在长期，意外的生育 与较高的贫困率和较低的家庭稳定相关。8年轻，贫穷，黑人和西班牙裔妇女，以及 收入较低或教育的妇女更有可能经历意外的短期怀孕。6,7应得 为了这些后果，2030年健康的人的目标是将短时妊娠减少20％.9 接收高效的节育，例如长效可逆避孕（LARC） 产后期（IPP；分娩和出院之间的时间）可以减少意外而短暂 间隔怀孕。然而，有40-75％的计划在计划使用LARC方法产后的妇女没有接受。10A IPP LARC宽度采用的主要障碍是无法获得LARC的报销 设备和插入立即提供了产后。为了解决这个障碍，一些州医疗补助 程序已开始为IPP LARC插入，设备或两者兼而有之报销 偿还劳动力和交付成本。缺少该政策，各国使用 “捆绑”付款不允许偿还单个程序，毒品或设备。现存的 医疗补助IPP LARC报销的证据仅限于单一医院或单一州内的分析 查看采用政策采用的短期影响（例如，医院实施和LARC吸收）或依靠 假设所有影响妊娠结局的因素的方法都可以用协变量来解释。这 研究旨在通过使用准确的长期，人口级的影响来填补证据的空白。 实验研究设计。首先，我将估计医疗补助IPP LARC偿还政策对 使用LARC方法产后和意外怀孕的可能性的可能性。接下来，我会的 估计报销政策对短期怀孕风险的影响。最后，我将估计 医院类型在多大程度上影响短时妊娠的风险。三种类型的医院，教学 医院，医疗补助患者比例很高的医院和340B实体可能对 政策变化是因为这些医院为妇女群体服务于较短的妇女人群，短时间间隔 怀孕并支持成功实施IPP LARC计划的结构。12,13此提案 与多个AHRQ研究的重点保持一致，包括种族/族裔少数民族，低收入，妇女和 获得护理。