TY - JOUR
T1 - Insurance coverage and discontinuity during pregnancy
T2 - Frequency and associations documented in the PROMISE cohort
AU - Booman, Anna
AU - Stratton, Kalera
AU - Vesco, Kimberly K.
AU - O'Malley, Jean
AU - Schmidt, Teresa
AU - Boone-Heinonen, Janne
AU - Snowden, Jonathan
N1 - Publisher Copyright:
© 2023 Health Research and Educational Trust.
PY - 2024/4
Y1 - 2024/4
N2 - Objective: To describe insurance patterns and discontinuity during pregnancy, which may affect the experiences of the pregnant person: their timely access to care, continuity of care, and health outcomes. Data Sources and Study Setting: Data are from the PROMISE study, which utilizes data from community-based health care organizations (CHCOs) (e.g., federally qualified health centers that serve patients regardless of insurance status or ability to pay) in the United States from 2005 to 2021. Study Design: This descriptive study was a cohort utilizing longitudinal electronic health record data. Data Collection/Extraction Methods: Insurance type at each encounter was recorded in the clinical database and coded as Private, Public, and Uninsured. Pregnant people were categorized into one of several insurance patterns. We analyzed the frequency and timing of insurance changes and care utilization within each group. Principal Findings: Continuous public insurance was the most common insurance pattern (69.2%), followed by uninsured/public discontinuity (11.8%), with 6.4% experiencing uninsurance throughout the entirety of pregnancy. Insurance discontinuity was experienced by 16.6% of pregnant people; a majority of these reflect people transitioning to public insurance. Those with continuous public insurance had the highest frequency of inadequate prenatal care (19.5%), while those with all three types of insurance during pregnancy had the highest percentage of intensive prenatal care (16.5%). The majority (71.7%–81.2%) of those with a discontinuous pattern experienced a single insurance change. Conclusions: Insurance discontinuity and uninsurance are common within our population of pregnant people seeking care at CHCOs. Our findings suggest that insurance status should be regarded as a dynamic rather than a static characteristic during pregnancy and should be measured accordingly. Future research is needed to assess the drivers of perinatal insurance discontinuity and if and how these discontinuities may affect health care access, utilization, and birth outcomes.
AB - Objective: To describe insurance patterns and discontinuity during pregnancy, which may affect the experiences of the pregnant person: their timely access to care, continuity of care, and health outcomes. Data Sources and Study Setting: Data are from the PROMISE study, which utilizes data from community-based health care organizations (CHCOs) (e.g., federally qualified health centers that serve patients regardless of insurance status or ability to pay) in the United States from 2005 to 2021. Study Design: This descriptive study was a cohort utilizing longitudinal electronic health record data. Data Collection/Extraction Methods: Insurance type at each encounter was recorded in the clinical database and coded as Private, Public, and Uninsured. Pregnant people were categorized into one of several insurance patterns. We analyzed the frequency and timing of insurance changes and care utilization within each group. Principal Findings: Continuous public insurance was the most common insurance pattern (69.2%), followed by uninsured/public discontinuity (11.8%), with 6.4% experiencing uninsurance throughout the entirety of pregnancy. Insurance discontinuity was experienced by 16.6% of pregnant people; a majority of these reflect people transitioning to public insurance. Those with continuous public insurance had the highest frequency of inadequate prenatal care (19.5%), while those with all three types of insurance during pregnancy had the highest percentage of intensive prenatal care (16.5%). The majority (71.7%–81.2%) of those with a discontinuous pattern experienced a single insurance change. Conclusions: Insurance discontinuity and uninsurance are common within our population of pregnant people seeking care at CHCOs. Our findings suggest that insurance status should be regarded as a dynamic rather than a static characteristic during pregnancy and should be measured accordingly. Future research is needed to assess the drivers of perinatal insurance discontinuity and if and how these discontinuities may affect health care access, utilization, and birth outcomes.
KW - access to care
KW - continuity of care
KW - health care utilization
KW - insurance churn
KW - insurance discontinuity
KW - maternal and child health
KW - prenatal care
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U2 - 10.1111/1475-6773.14265
DO - 10.1111/1475-6773.14265
M3 - Article
C2 - 38123135
AN - SCOPUS:85180207898
SN - 0017-9124
VL - 59
JO - Health Services Research
JF - Health Services Research
IS - 2
M1 - e14265
ER -