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. 2023 Jun 1;6(6):e2316536.
doi: 10.1001/jamanetworkopen.2023.16536.

Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review

Ian J Saldanha  1   2 , Gaelen P Adam  2 , Ghid Kanaan  2 , Michael L Zahradnik  2 , Dale W Steele  2   3 , Kenneth K Chen  4 , Alex F Peahl  5 , Valery A Danilack-Fekete  6   7 , Alison M Stuebe  8 , Ethan M Balk  2
Affiliations

Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review

Ian J Saldanha et al. JAMA Netw Open. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Saldanha reported other from Agency for Healthcare Research and Quality Contract and other from Patient-Centered Outcomes Research Institute Contract during the conduct of the study. Mr Adam reported grants from AHRQ during the conduct of the study. Dr Peahl reported other from Maven Consultant during the conduct of the study. Dr Danilack-Fekete reported personal fees from AHRQ during the conduct of the study. Dr Stuebe reported grants from AHRQ, grants from NIH, grants from PCORI, and grants from American Heart Association during the conduct of the study. Dr Balk reported grants from Agency for Healthcare Research and Quality during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Identification of Studies in This Systematic Review
See this image and copyright information in PMC

Comment in

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