平价医疗法案的避孕覆盖要求对处方口服避孕药的使用和自付费用的影响。
Effects of the Affordable Care Act's contraceptive coverage requirement on the utilization and out-of-pocket costs of prescribed oral contraceptives.
机构信息
Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI 53705-2222, USA.
Social and Administrative Sciences Division, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave., Madison, WI 53705-2222, USA.
出版信息
Res Social Adm Pharm. 2018 May;14(5):479-487. doi: 10.1016/j.sapharm.2017.06.005. Epub 2017 Jun 17.
BACKGROUND
The Affordable Care Act (ACA) mandated that private health insurance plans cover prescribed contraceptive services for women, including oral contraceptives (OCs), without charging a patient any cost-sharing beginning in August 2012.
OBJECTIVE
To evaluate the effects of the ACA's contraceptive coverage requirement on the utilization and out-of-pocket costs of prescribed OCs after two years of implementation.
METHODS
A retrospective, cross-sectional study was designed using data from the 2010 to 2014 waves of the Medical Expenditure Panel Survey. The sample consisted of reproductive-aged women who have either private health insurance or Medicaid. Utilization of OCs was evaluated using 1) the proportion of women who purchased any OCs and 2) the mean annual number of cycles prescribed per woman. Out-of-pocket costs for OCs were evaluated using 1) the proportion of women who had any OC purchase with $0 out-of-pocket costs, 2) the mean annual out-of-pocket costs per woman, and 3) the mean out-of-pocket costs per cycle. Descriptive analyses and a difference-in-difference linear regression approach were used.
MAIN FINDINGS
No substantial changes were seen in the utilization of OCs after the ACA requirement became effective. The difference-in-difference regression showed that the proportion of women who had any OC purchase with $0 out-of-pocket costs increased significantly by 54.0 percentage points after the ACA requirement in the private insurance group relative to the Medicaid group. Mean annual out-of-pocket costs in the private insurance group dropped by 37% in the first year and an additional 52% decrease was found in the second year of the policy. Mean out-of-pocket costs per cycle also decreased substantially in the private insurance group by 39% in the first year and an additional decrease of 44% was seen in the second year.
CONCLUSIONS
The ACA's contraceptive coverage requirement markedly reduced out-of-pocket costs of prescribed OCs for women with private health insurance.
背景
平价医疗法案（ACA）要求私人医疗保险计划为女性提供处方避孕药具（OC）的覆盖，自 2012 年 8 月起，不得向患者收取任何费用分担。
目的
评估 ACA 避孕覆盖要求在实施两年后对指定口服避孕药的使用和自付费用的影响。
方法
采用 2010 年至 2014 年医疗支出面板调查数据进行回顾性、横断面研究。样本由有私人医疗保险或医疗补助的育龄妇女组成。OC 的使用情况通过以下两种方法评估：1）购买任何 OC 的女性比例；2）每位女性每年平均开处方的周期数。OC 的自付费用通过以下三种方法评估：1）没有任何 OC 购买自付费用的女性比例；2）每位女性每年平均自付费用；3）每个周期的平均自付费用。采用描述性分析和差异-差异线性回归方法。
主要发现
ACA 要求生效后，OC 的使用没有明显变化。差异-差异回归显示，在私人保险组中，与医疗补助组相比，自付费用为 0 的 OC 购买者比例在 ACA 要求生效后显著增加了 54.0 个百分点。私人保险组的年平均自付费用在政策实施的第一年下降了 37%，第二年又下降了 52%。每个周期的平均自付费用在私人保险组也大幅下降，第一年下降了 39%，第二年又下降了 44%。
结论
ACA 的避孕覆盖要求显著降低了拥有私人医疗保险的女性处方避孕药具的自付费用。
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