Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
Womens Health Issues. 2019 Nov-Dec;29(6):465-470. doi: 10.1016/j.whi.2019.07.006. Epub 2019 Sep 5.
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.
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).
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).
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.
自付费用可能会阻碍产后避孕措施的使用。我们评估了商业保险产后女性自付费用与长效可逆避孕（LARC）放置之间的关系。
使用 Clinformatics 数据集市，我们检查了 2013 年至 2016 年期间雇主赞助健康计划中产后 0 至 3 天和 4-60 天内 LARC 插入的自付费用。通过汇总 LARC 服务（设备+放置）的共付额、自付额和免赔额来估计患者费用。多变量逻辑回归评估了 LARC 服务（至少有一名受益人的自付费用超过 200 美元）计划成本分担与产后 60 天内 LARC 放置（是/否）之间的关联。
我们在 51797 个雇主基础计划中确定了 396073 例分娩。总体而言，产后 60 天内放置 LARC 的比例为 5.2%（n=20604）。住院 LARC 插入（n=233；占分娩的 0.06%）比门诊 LARC 插入（n=20375；占分娩的 5.14%）少见。在 23.4%的 LARC 放置中观察到费用分担（宫内节育器：中位数，50.00 美元；范围，0.93-5055.91 美元；宫内节育器：中位数，11.91 美元；范围，2.49-650.14 美元；门诊宫内节育器：中位数，25.00 美元；范围，0.01-3354.80 美元；门诊植入物：中位数，27.20 美元；范围，0.18-2444.01 美元）。在至少有一次 LARC 放置的 5895 个计划中，在调整了患者年龄、贫困状况、种族/民族、地区和计划类型后，自付费用超过 200 美元的女性产后 60 天内 LARC 使用的可能性较低（比值比，0.74；95%置信区间，0.71-0.77）。
产后 LARC 的费用分担与使用相关，这表明自付费用可能会阻碍一些商业保险产后女性使用 LARC。降低最有效的避孕形式的自付费用可能会增加使用。
