Use of Sexual and Reproductive Health Services Among Women Living in Rural and Urban Oregon: Impact of the Affordable Care Act Medicaid Expansion

被引:1
|
作者
Masoumirad, Mandana [1 ,4 ]
Harvey, S. Marie [1 ]
Bui, Linh N. [2 ]
Yoon, Jangho [1 ,3 ]
机构
[1] Oregon State Univ, Coll Publ Hlth & Human Sci, Corvallis, OR USA
[2] Calif State Univ, Sch Nat Sci Math & Engn, Bakersfield, CA USA
[3] Uniformed Serv Univ Hlth Sci, Sch Med, Bethesda, MD USA
[4] Oregon State Univ, Coll Publ Hlth & Human Sci, 2631 SW Campus Way, Corvallis, OR 97331 USA
关键词
sexual and reproductive health services; Medicaid expansion; Oregon; preventive care; PELVIC-INFLAMMATORY-DISEASE; INTERRUPTED TIME-SERIES; TRANSMITTED-DISEASES; UNINTENDED PREGNANCY; INSURANCE-COVERAGE; ADOLESCENTS; RISK; CONTRACEPTION; BEHAVIORS; CHLAMYDIA;
D O I
10.1089/jwh.2022.0308
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objectives: We compared the use of sexual and reproductive health (SRH) services for Medicaid-enrolled women of reproductive age (WRA) living in Oregon by urban/rural status and examined the effect of the Affordable Care Act (ACA) Medicaid expansion on the use of SRH services for these women.Methods: We linked Oregon Medicaid enrollment files and claims for the years 2008-2016 to identify 392,111 WRA. Outcome measures included receipt of five key SRH services. The main independent variables were urban/rural status (urban, large rural cities, and small rural towns) and an indicator for the post-Medicaid expansion time period (2014-2016). We performed (conditional) fixed-effects logistic regression and multiple-group interrupted time-series analyses.Results: Women living in small rural towns were less likely than women living in urban areas to receive well-woman visits (odds ratio [OR] = 0.87; 95% confidence interval [95% CI] [0.80-0.94]), sexually transmitted infection (STI) screening (OR = 0.81; 95% CI [0.72-0.90]), and pap tests (OR = 0.91; 95% CI [0.84-0.99]). Women living in large rural cities were less likely than women living in urban areas to receive STI screening (OR = 0.91; 95% CI [0.84-0.98]). Following the implementation of ACA Medicaid expansion, the average number of all five SRH services increased for all women. With the exception of contraceptive services, the average number of SRH services examined increased more for urban women than for women living in small rural towns.Conclusions: Although Medicaid expansion contributed to increased use of SRH services for all WRA, the policy was unsuccessful in reducing disparities in access to SRH services for WRA living in rural areas compared with urban areas.
引用
收藏
页码:300 / 310
页数:11
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