Cost Sharing and Utilization of Postpartum Intrauterine Devices and Contraceptive Implants Among Commercially Insured Women
| Autor: | Giselle E. Kolenic, Anca Tilea, Ann B. Soliman, Sarah Bell, A. Mark Fendrick, Vanessa K. Dalton, Michelle H. Moniz |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Health (social science) Adolescent Logistic regression Poverty status Odds Young Adult 03 medical and health sciences 0302 clinical medicine Pregnancy Patient age Maternity and Midwifery Odds Ratio medicine Humans 030212 general & internal medicine Cost Sharing Contraception Behavior Long-Acting Reversible Contraception Copayment Insurance Health 030219 obstetrics & reproductive medicine Obstetrics business.industry Postpartum Period Public Health Environmental and Occupational Health Obstetrics and Gynecology Odds ratio United States Confidence interval Logistic Models Cost sharing Female business Intrauterine Devices |
| Zdroj: | Women's Health Issues. 29:465-470 |
| ISSN: | 1049-3867 |
| Popis: | Background Cost sharing may impede postpartum contraceptive use. We evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Methods Using the Clinformatics Data Mart, we examined out-of-pocket costs for LARC insertions at 0 to 3 and 4–60 days postpartum among women in employer-sponsored health plans from 2013 to 2016. Patient costs were estimated by summing copayment, coinsurance, and deductible payments for LARC services (device + placement). Multivariable logistic regression evaluated the association between plan cost sharing for LARC services (at least one beneficiary with >$200 cost share) and LARC insertion by 60 days postpartum (yes/no). Results We identified 396,073 deliveries among women in 51,797 employer-based plans. Overall, LARC placement by 60 days postpartum was observed after 5.2% (n = 20,604) of deliveries. Inpatient LARC insertion (n = 233; 0.06% of deliveries) was less common than outpatient LARC insertion (n = 20,375; 5.14% of deliveries). Cost sharing was observed in 23.4% of LARC insertions (inpatient IUD: median, $50.00; range, $0.93–5,055.91; inpatient implant: median, $11.91; range, $2.49–650.14; outpatient IUD: median, $25.00; range, $0.01–3,354.80; outpatient implant: median, $27.20; range, $0.18–2,444.01). Among 5,895 plans with at least one LARC insertion and after adjusting for patient age, poverty status, race/ethnicity, region, and plan type, women in plans with cost sharing of more than $200 demonstrated lower odds of LARC use by 60 days postpartum (odds ratio, 0.74; 95% confidence interval, 0.71–0.77). Conclusions Cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. Reducing out-of-pocket costs for the most effective forms of contraception may increase use. |
| Databáze: | OpenAIRE |
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