Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Contraception. 2013 Dec;88(6):691-6. doi: 10.1016/j.contraception.2013.08.004. Epub 2013 Aug 14.
Medicaid sterilization policy, which includes a mandatory 30-day waiting period between consent and the sterilization procedure, poses significant logistical barriers for many women who desire publicly funded sterilization. Our goal was to estimate the number of unintended pregnancies and the associated costs resulting from unfulfilled sterilization requests due to Medicaid policy barriers.
We constructed a cost-effectiveness model from the health care payer perspective to determine the incremental cost over a 1-year time horizon of the current Medicaid sterilization policy compared to a hypothetical, revised policy in which women who desire a postpartum sterilization would face significantly reduced barriers. Probability estimates for potential outcomes in the model were based on published sources; costs of Medicaid-funded sterilizations and Medicaid-covered births were based on data from the Medicaid Statistical Information System and The Guttmacher Institute, respectively.
With the implementation of a revised Medicaid sterilization policy, we estimated that the number of fulfilled sterilization requests would increase by 45%, from 53.3% of all women having their sterilization requests fulfilled to 77.5%. Annually, this increase could potentially lead to over 29,000 unintended pregnancies averted and $215 million saved.
A revised Medicaid sterilization policy could potentially honor women's reproductive decisions, reduce the number of unintended pregnancies and save a significant amount of public funds.
Compared to the current federal Medicaid sterilization policy, a hypothetical, revised policy that reduces logistical barriers for women who desire publicly funded, postpartum sterilization could potentially avert over 29,000 unintended pregnancies annually and therefore lead to cost savings of $215 million each year.
医疗补助绝育政策（包括在同意和绝育手术之间设置 30 天的强制性等待期）对许多希望接受公共资金绝育的女性来说，带来了重大的后勤障碍。我们的目标是估计由于医疗补助政策障碍而未得到满足的绝育请求导致的意外怀孕数量和相关成本。
我们从医疗保健支付者的角度构建了一个成本效益模型，以确定与假设的修订政策相比，当前医疗补助绝育政策在 1 年时间范围内的额外成本，在修订政策中，希望进行产后绝育的女性将面临明显减少的障碍。模型中潜在结果的概率估计基于已发表的资料；模型中医疗补助资助的绝育和医疗补助覆盖的分娩的成本分别基于医疗补助统计信息系统和盖特马赫研究所的数据。
实施修订后的医疗补助绝育政策后，我们估计满足绝育要求的请求数量将增加 45%，从所有女性中满足绝育要求的 53.3%增加到 77.5%。每年，这一增长可能会避免超过 29,000 例意外怀孕，并节省 2.15 亿美元。
修订后的医疗补助绝育政策可能会尊重妇女的生殖决策，减少意外怀孕的数量，并节省大量公共资金。
与当前的联邦医疗补助绝育政策相比，假设减少了希望接受公共资金、产后绝育的女性的后勤障碍的修订政策，每年可能会避免超过 29,000 例意外怀孕，因此每年可节省 2.15 亿美元。
