Raidoo Shandhini, Tschann Mary, Kaneshiro Bliss, Sentell Tetine
Department of Obstetrics, Gynecology, and Women's Health, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (SR, MT, BK).
Office of Public Health Studies, University of Hawai'i, Honolulu, HI (TS).
Hawaii J Health Soc Welf. 2020 Apr 1;79(4):117-122.
Insurance coverage for abortion varies between states, and in Hawai'i most private insurance companies and state Medicaid provide coverage for abortion. Very few patients pay out-of-pocket for an abortion. Hawai'i presents a unique opportunity to describe the sociodemographic differences between women seeking an abortion based on type of insurance coverage or who self-pay, and how this coverage impacts their care. Examined here were the differences in gestational age at time of presentation for abortion and type of abortion (medical, in-office procedure, or hospital facility procedure) chosen by 1803 patients presenting to a major abortion provider in Hawai'i from 2010 to 2013 based on payment method: private insurance, state Medicaid, and self-pay. Self-pay patients were demographically similar to those using private insurance with respect to age, race, and gestational age at time of presentation. Medicaid patients were distinct. They presented for care at a gestational age 13.3 days later than private insurance or self-pay patients even when controlling for age, race, prior parity, and prior abortion. Overall, 45.3% of Medicaid patients presented at greater than 14 weeks. Types of abortion differed between the insurance category groups, however these differences were no longer significant when stratified by gestational age. State Medicaid patients present for abortion care almost 2 weeks later than those with private insurance or who pay out of pocket, increasing personal and healthcare system costs associated with the procedure. The factors that contribute to this difference should be elucidated as they have important public health implications regarding timely access to care.
各州的堕胎保险覆盖情况各不相同，在夏威夷，大多数私人保险公司和州医疗补助项目都为堕胎提供保险。很少有患者自费进行堕胎。夏威夷提供了一个独特的机会来描述基于保险覆盖类型或自费情况寻求堕胎的女性之间的社会人口统计学差异，以及这种保险覆盖如何影响她们的护理。这里研究的是2010年至2013年期间，在夏威夷一家主要堕胎服务提供者处就诊的1803名患者，根据支付方式（私人保险、州医疗补助和自费）在堕胎时的孕周差异以及所选择的堕胎类型（药物流产、门诊手术或医院手术）。自费患者在年龄、种族和就诊时的孕周方面在人口统计学上与使用私人保险的患者相似。医疗补助患者则不同。即使在控制了年龄、种族、既往产次和既往堕胎情况后，他们就诊时的孕周比私人保险或自费患者晚13.3天。总体而言，45.3%的医疗补助患者在超过14周时就诊。保险类别组之间的堕胎类型存在差异，然而，按孕周分层后这些差异不再显著。州医疗补助患者寻求堕胎护理的时间比有私人保险或自费的患者晚近两周，这增加了与该手术相关的个人和医疗系统成本。导致这种差异的因素应予以阐明，因为它们对于及时获得护理具有重要的公共卫生意义。
