Armstrong Mary Anne, Postlethwaite Debbie A, Darbinian Jeanne A, McCoy Mark, Law Amy
1 Division of Research , Kaiser Permanente, Oakland, California.
2 Bayer HealthCare Pharmaceuticals Inc. , Whippany, New Jersey.
J Womens Health (Larchmt). 2017 May;26(5):450-460. doi: 10.1089/jwh.2014.5146. Epub 2016 Oct 18.
In 2007, high-deductible plans were added to the primarily nondeductible Kaiser Permanente Northern California (KPNC) integrated health plan, which had covered 100% of device and procedure costs of long-acting reversible contraception (LARC) for members regardless of prescription/visit copay amount. We hypothesized that nondeductible plans and prior LARC use decreased unintended pregnancy.
The purpose of this study was to determine if health plan design (nondeductible vs. deductible) and LARC use before pregnancy were associated with pregnancy intention.
In this retrospective cohort study, women aged 15-44 as of the index date of June 30, 2010 were followed from January 1, 2010 to December 31, 2012 for evidence of pregnancy (n = 65,989). Health plan design, copays, contraceptive method used most recently before the pregnancy, and self-reported pregnancy intention status (intended, mistimed, unwanted) were obtained from electronic medical records. Logistic regression models were developed to determine if various health plan designs, copays, or prior LARC use were associated with pregnancy intention, controlling for potential confounders such as age, race/ethnicity, marital status, education/income, parity, and comorbidities.
In all models, LARC use before pregnancy versus non-LARC use was significantly related to intended pregnancies (all models: odds ratio [OR] = 2.26, 95% confidence interval [CI] 2.06-2.48). Women with deductible plans with healthcare spending accounts (HSA) were more likely to report intended pregnancies versus women with nondeductible plans (all models: OR = 1.2, 95% CI 1.04-1.30). In stratified analyses, high income/high education was a significant predictor of intended pregnancy regardless of race/ethnicity.
LARC use before pregnancy and having an HSA were associated with intended pregnancy.
2007年，高免赔额计划被纳入主要为无免赔额的北加利福尼亚凯撒医疗集团（KPNC）综合健康计划，该计划此前无论处方/就诊自付费用多少，都为会员100%报销长效可逆避孕法（LARC）的器械和手术费用。我们推测，无免赔额计划和既往使用LARC可降低意外怀孕率。
本研究旨在确定健康计划设计（无免赔额与有免赔额）以及怀孕前LARC的使用情况是否与怀孕意愿相关。
在这项回顾性队列研究中，对截至2010年6月30日索引日期年龄在15 - 44岁的女性，从2010年1月1日至2012年12月31日进行随访，以获取怀孕证据（n = 65,989）。从电子病历中获取健康计划设计、自付费用、怀孕前最近使用的避孕方法以及自我报告的怀孕意愿状态（计划内、时机不当、意外怀孕）。建立逻辑回归模型，以确定各种健康计划设计、自付费用或既往LARC使用情况是否与怀孕意愿相关，并控制年龄、种族/民族、婚姻状况、教育程度/收入、生育史和合并症等潜在混杂因素。
在所有模型中，怀孕前使用LARC与未使用LARC相比，与计划内怀孕显著相关（所有模型：比值比[OR] = 2.26，95%置信区间[CI] 2.06 - 2.48）。与有无免赔额计划的女性相比，拥有带医疗保健支出账户（HSA）的免赔额计划的女性更有可能报告计划内怀孕（所有模型：OR = 1.2，95% CI 1.04 - 1.30）。在分层分析中，无论种族/民族如何，高收入/高学历都是计划内怀孕的重要预测因素。
怀孕前使用LARC和拥有HSA与计划内怀孕相关。
