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- Title
Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review.
- Authors
Saldanha, Ian J.; Adam, Gaelen P.; Kanaan, Ghid; Zahradnik, Michael L.; Steele, Dale W.; Chen, Kenneth K.; Peahl, Alex F.; Danilack-Fekete, Valery A.; Stuebe, Alison M.; Balk, Ethan M.
- Abstract
This systematic review evaluates the association between health insurance coverage extensions or improvements and postpartum outcomes in the US. Key Points: Question: Are health insurance coverage extension or improvements in access to health care associated with postpartum health care utilization and maternal outcomes within 1 year post partum? Findings: This systematic review included 28 mostly moderate-risk-of-bias nonrandomized studies. An association between more comprehensive insurance and greater attendance at postpartum visits was observed in some studies based on a moderate strength of evidence; for other types of postpartum health care outcomes, the strength of evidence for association with insurance coverage improvement was low. Meaning: These findings suggest that evidence identified is, at best, of moderate strength; future research should evaluate the impact of more comprehensive or extended health insurance on health outcomes in the postpartum period and beyond. Importance: Approximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care. Objective: To assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum. Evidence Review: Medline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide. Findings: A total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits. Conclusions and Relevance: The findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
- Subjects
UNITED States; CINAHL database; HEALTH policy; HEALTH services accessibility; MEDICAL information storage &; retrieval systems; HOSPITAL emergency services; SYSTEMATIC reviews; MENTAL health; PATIENT readmissions; PREGNANCY outcomes; MEDICAL care use; HEALTH insurance; QUALITY assurance; RESEARCH funding; POSTNATAL care; MEDLINE; MEDICAID; INSURANCE
- Publication
JAMA Network Open, 2023, Vol 6, Issue 6, pe2316536
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.16536