Development and validation of a claims-based measure of abortion services.

RATIONALE

Data on abortion services are critical for monitoring trends in access and utilization, evaluating policies, and examining a wide range of research questions. Accurate and timely data, however, can be difficult to obtain for abortion services. Oregon is one of several states that use state funds to finance abortion services in their Medicaid programmes. Oregon's Medicaid programme contracts with managed care plans that receive global budgets to provide care. Abortion services, however, must be billed directly to the state through fee-for-service (FFS) billing to ensure that federal funds are not used. In this study, we identify possible abortions using Medicaid insurance claims data from Oregon and categorize identified abortions as high, medium, or low confidence according to convergent validity analysis of FFS billing.

METHODS

We used individually linked Medicaid eligibility and claims data from women ages 15 to 44 enrolled in Oregon's Medicaid programme from 2008 to 2013. Abortion-related Medicaid claims were identified and categorized based on diagnosis, procedure, and drug codes. These categories were assessed for convergent validity by examining FFS billing for possible abortions to women enrolled in managed care plans.

RESULTS

In total, 23 763 possible abortions obtained by 18 518 women were classified with high (n = 21 450), medium (n = 562), and low (n = 1751) confidence. Among managed care abortions, more than 99% of high confidence abortions were billed on an FFS basis compared with 72% of medium confidence and <1% of low confidence abortions. The majority of high confidence abortions were to urban-residing (89%) white (73%) women.

CONCLUSIONS

Research on abortion services using insurance claims has important implications for women's health care and public health policy. A high-quality claims-based measure can facilitate monitoring the provision of abortion services within health systems and evaluation of initiatives to increase equitable abortion access.